NCC231264_FRO Submitted_20230501

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 ally 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 DJJ Monroe Scrap Processing
2. Address where land disturbing activity will take place 179 S Bivens Road, Monroe, NC 28112
Parcel #'s: 090-8701-1; 090-8700-4A
3. Approximate date disturbing activity will commence 01 / 17 / 2023
4. Purpose of development(residential,commercial,industrial,etc.) Industrial
5. Total acreage of land to be disturbed or uncovered 11 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.) $1500 (Previously Paid)
7. Agent to contact should sediment control issues arise during land disturbing activity
Jeff Myers 704-681-1477
Name Phone
8. Landowner(s)of Record(use blank page to list additional owners)
Name Metal Recycling Services, LLC Name
Mailing Address 334 Beachwood Road,Ste 401 Mailing Address
Ft. Mitchell, KY 41017
Street Address 150 S. Bivens Road Street Address
Monroe, NC 28112
Phone [phone] Phone
Fax [phone] 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
4854 Book 8163
Page 450 Page 0436
10. Tax Map Parcel Number where land disturbing activity will take place 090 -- 8700 -- 4A
090 -- 8701 -- 1
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 Metal Recycling Services, LLC Name
Mailing Address 334 Beechwood Road,Ste 401 Mailing Address
Ft. Mitchell, KY 41017
Street Address 150 S. Bivens Road Street Address
Monroe, NC 28112
Phone [phone] Phone
Fax [phone] Fax
2. A)lithe 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. lithe Financially Responsible Party is a
Corporation,give the name and street address of the Registered Agent:
Name of Registered Agent
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. 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 A �•. S. Lappin Title Controller
,;i�Signature �I Date �� / j / �3
i
�t b kO 1"-
i, ' l,a Notary Public of the County of 9 ,State of North Carolina,
hereby certify that �lrt f` S,1 +++(!�,/> appeared personally before me this day and being duly sworn acknowledged
that the above font]was executed by him. i
Witness my hand and notarial seal,this 1 day of J 0-'1 ',1-13 2-02-3
(� I
..SEAL /! - ?\QU'l\
(Notary)
My commission expires L��5")) 202 3 ?
07-19 Permits, Checklists, and Forms
Division 07