NCC223374_FRO Submitted_20220928

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
I. Name of Project The Ridge at 601
2 Address where land disturbing activity will take place 219 Ridge Road Monroe, NC 28110
3. Approximate date' disturbing activity will commence 01 01'i / 2022
4. Purpose of development (residential, commercial; industrial, etc..) Residential
5. Total acreage of land to be disturbed or uncovered 57'Acres
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.} $6,100'
7. Agent to contact should sedimentcontrol issues arise during land disturbing activity
Name 601 Bypass Land, LLC Phone [phone]
8. Landowner(s) of Record (use blank page to list additional owners)
Name Ridge Road Partners LLC Name 601 Bypass Land, LLC
ao Box 1609 Monroe, NC 29110
Mailing Address Mailing Address 4521 Sharon Rd, Suite 450
Monroe, NC 28110 Charlotte, NC 28211
4030 Wake Forest Rd STE 349
Street Address Street Address
Raleigh, NC 27609
Phone [phone] Phone
Fax 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 8081 Book 8361 6851
Page 716 Page 0086 880
10. ' Tax Map Parcel Number where land disturbing activity will take place 09 -- 213 __ 008C
09 __ 213 __ 008K
09 213 __ 008
07-18 Permits, Checklists, and Forms
Division 07

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
Part II
1. Person(s) or firm(s) who are financially responsible for this land disturbing activity (use blank page to list
additional owners)
Name Ridge Road Partner LLC of NC Name
Mailing Address 4030 Wake Forest Rd STE 349 Mailing Address
Raleigh, NC 27609
Street Address 4030 Wake Forest Rd STE 349 Street Address
Raleigh, NC 27609
Phone [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 Registered Agents Inc
Mailing Address 4030 Wake Forest Rd STE 349, Raleigh, NC 27609
Street address City State Zip
919-400-4138
Phone Email F
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 personif an individual or his attorney in fact;
or if not anindividual, by an officer., director, partner, or registered agent with. authority to. execute instruments
for the financially responsible person) ��,,✓-
Type or Print Title Date /�L�✓✓ M"" / -
Signature
f, . a Notary Public ofthe County of Union State of North Carolina,
/
hereby certify that ��"1 HI appeared personally before me this day and being chly sworn acknowledged
that the above forth was executed by him. Witness my hand and notarial seal. this Z ' I
'1 day of 5 c4 mber , 20Z1
1AIYCI
ANNAH L RUSHING (Notary)
NOTARY PU—]
BLIC //--
Union County My commission expires W' ZO-ZOZ�
North Carolina
My Commission Expires June 20, 2024 07-19 Permits, Checklists, and Forms
Division 07