NCC230487_FRO Submitted_20230223

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 Stewarts Crossing
2. Address where land disturbing activity will take place 3417 Secrest Short Cut Rd, Monroe, NC
3. Approximate date disturbing activity will commence 1 / 2 / 2023
4. Purpose of development (residential, commercial, industrial, etc.) residential
5. Total acreage of land to be disturbed or uncovered 15.6
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.) $2,000
7. Agent to contact should sediment control issues arise during land disturbing activity
Name Travis Manning Phone [phone]
8. Landowner(s) of Record (use blank page to list additional owners)
Name. AMH NC Development TRS LP Name_
Mailing Address 23975 Park Sorrento, Suite 300 Mailing Address_ _
Calabasas, CA 91302
Street Address 23975 Park Sorrento, Suite 300 Street Address
Calabasas, CA 91302
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 8366 Book 8366
Page 295 Page 297
10. Tax Map Parcel Number where land disturbing activity will take place 092560'3A
09256003
07-18 Permits, Checklists, and Forms
Division 07

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
Part II
l . Person(s) or firm(s) who are financially responsible for this land disturbing activity (use blank page to list
additional owners)
Name AMH NC Development TRS LP Name
Mailing Address16905 Northcross Drive, Suite 200 Mailing Address
Huntersville, NC 28078
Street Address 160 Mine Lake Ct Ste 200 Street Address_ -
Raleigh, NC 27615
Phone [phone]
Fax
Phone
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
Street address
Phone
Email
City State
Fax
Zip
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
Mailing Address
Street address City State Zip
Phone Email Fax
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath. l 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 ark J Mahoney Title / VP of Land
Signature AA& -4V1 J1. Date
i, TA6 i r1 A._ a Notary Public of the County of C b�lif Y 1�1s State of North Carolina,
i"4�i -9 4 hereby certify that : IIIQVItM appeared personally before me this day and being cLly sworn acknowledged
that the above form was executed by him.
Witness my hand and notarial seal, this'VIA day of
SEAL-.`'°``�NAtJty'4(���i� —•— —
�Q (Notary)
osAAY
M
- - 2
yV y commission expires _
G Z = 07-19 Permits, Checklists, and Forms
�B``
Division 07
.