NCC222329_FRO Submitted_20220624

Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
No person may initiate any land -disturbing activity on one or more acres as covered by the ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Rowan County
Environmental Management Department.
Part A
1. Project Name
runcam Koaa lownhomes
2. Location of land -disturbing activity (Highway/Street)
runcaia Koaa Salisbury NC
Latitude
Longitude
35.637984 180.465946
4
3. Approximate date land -disturbing activity will be commenced
5/ 18/2022
Parcel ID Number
i065-094
4. Purpose of development (residential, commercial, industrial, etc.)
Residential
5. Approximate acreage of land to be disturbed or uncovered
In/a - change of ownership
6. Person to contact should sediment control issues arise during land -disturbing Cell Phone Number
activity
;Andrew McDonald 704-288-7256
Email Address
[e-mail]

7. Landowner of Record
Landowner of Record
TRUE SFR 2, LLC
Name
Current Mailing Address
Name
Current Mailing Address
2649 Brekonridge Center Drive Monroe NC 28110
8. Recorded in Deed Book Number Page Number
Part B
1. Person or Firm who are financially responsible for this
land -disturbing activity
Andrew McDonald., True Homes, LLC
Name of Person(s) or Firm(s)
Current Mailing Address
2649 Brekonridge Center Drive Monroe NC 28110
Person or Firm who are financially responsible for this
land -disturbing activity
Name of Person(s) or Firm(s)
Current Mailing Address
Phone Number Phone Number
704-288-7256
i
a. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
Current Mailing Address Current Mailing Address
Phone Number Phone Number

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
Current Mailing Address Current Street Address
Telephone Number Telephone Number
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath. (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).
I agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
Signature Date
m m/dd/yyyy
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.................................................................................
I, -- �� Li._ , a Notary Public of the County of ��-r�� State of North Carolina,
hereby certify th Y ,"1�. O`tS-'�,,-,-'�ppeared personally before me this day and being duly sworn acknowledged
that the above form was executed by him/her. Witness my hand and seal of Notary, this ib day of 20 .
Notary My commission expires
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mm/dd/yyyy bS
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Seal
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Checklist 1`,
Download a copy of the Erosion and Sedimentation �� o� CRY
Control Plan Checklist (PDF), - '� "� t)
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