NCC241346_FRO Submitted_20240507

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
07.06 EROSION CONTROL FORMS AND CHECKLISTS
07.06.01 EROSION CONTROL FINANCIAL RESPONSIBILITY FORM
No person may initiate any land-disturbing activity as defined in Chapter 158 of the Monroe City Code prior to
completion of this form,and an applicable and acceptable erosion and sedimentation control plan has been approved by
the City of Monroe Engineering Department. (Please type or print)
Part I
1. Name of Project EMH Imports
2. Address where land disturbing activity will take place 4203 W Highway 74
3. Approximate date disturbing activity will commence 12 / 01 / 2023
4. Purpose of development(residential,commercial,industrial,etc.) Commerical
5. Total acreage of land to be disturbed or uncovered 0.49
6. Amount of fee enclosed(fee will be the amount of current policies per acre multiplied by the total number
of acres or any part of an acre from number 5. i.e.7.28 acres equals 8 acres.) $500.00
7. Agent to contact should sediment control issues arise during land disturbing activity
Name Khusein Movlyudovich Aliyev Phone [phone]
8. Landowner(s)of Record(use blank page to list additional owners)
Name EMH Imports, LLC Name
Mailing Address 4549 Tradd Circle Mailing Address
Monroe, NC 28110
Street Address 3219 W. Highway 74 Street Address
Monroe, NC 28110
Phone [phone] Phone
Fax N/A Fax
9. Indicate Book and Page where deed of the property where land disturbing activity will take place is recorded
(use blank page to list additional owners)
Book 07176 Book
Page 0347-0349 Page
10. Tax Map Parcel Number where land disturbing activity will take place 093 __36 -- 004
07-18 Permits, Checklists, and Forms
Division 07

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
Part II
I. Person(s)or firm(s)who are financially responsible for this land disturbing activity(use blank page to list
additional owners)
Name EMH Imports, LLC Name
Mailing Address 4549 Tradd Circle Mailing Address
Monroe, NC 28110
Street Address 4549 Tradd Circle Street Address
Monroe, NC 28110
Phone Phone
Fax Fax
2. A)if the Financially Responsible Party is not a resident of North Carolina,give name and address of a North
Carolina Agent
Name of Registered Agent
Mailing Address
Street address City State Zip
Phone Email Fax
B) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed
name,attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a
Corporation,give the name and street address of the Registered Agent:
Name of Registered Agent Khusein Movlyudovich Aliyev
Mailing Address 4549 Tradd Circle Monroe NC 28110
Street address City State Zip
Phone [phone] Email [e-mail] Fax n/a
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath. I agree to provide corrected information should there be any change in the information provided
herein.(This form must be signed by the financially responsible person if an individual or his attorney in fact,
or if not an individual,by an officer,director,partner,or registered agent with authority to execute instruments
for the financially responsible person) /.�
Type or Print Name r .s'�tl1 fJ([y'e Title 0U"PPP'.
Signature Date 0 9 / l / ,1 0 ( Z
I.SllL/te 1. (mil& .allotary Public of the County of UniOV .Stale of North Carolina,
hereby certify that..JjuSei/1 novirOkI 4Ch miry appeared personally before me this day and being dtly sworn acknowledged
that the above Iimn was executed by him. }
Witness my hand and notarial seal,this J s3 1 day of rp U j p Iero r n, �U z3
191,067ittl
KAYLE A. SCHMIDT (Notary
Notary Public, North Carolina RUr��a is l 262g
Union County My commission expires
My Commission Expires 07-19 Permits, Checklists,and Forms
February 15;2028
r Division 07