NCC232342_FRO Submitted_20230804

5/31123. 12:23 PM Rowan County
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 Parcel ID Number
477 033
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1.Project Name*
The Yard, P:iase 1
2.Location of land-disturbing activity(Highway/Street)*
South of intersection of Grace Church Rd a-id S Main St. Salisbury
Latitude Longitude
35.612939w -80.336791
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3.Approximate date land-disturbing activity will be commenced
mmlddlYYYY 7.1 .2023
4.Purpose of development(residential,commercial,indus(rial,etc.)
Outdoor Storagc&Parking
5.Approximate acreage of land to be disturbed or uncovered*
6.57 Ades
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6.Person to contact should sediment control issues arise during land-disturbing activity* Cell Phone Number*
Jamie Ycxtheimer
704-756-463D
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"this information will be made available on the Rowan County Planning&Development website.
Email Address
jamieajd000dru:n.con
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7.Landowner of Record Landowner of Record
The Storage Yard,LLC
Name Name
https:llwww.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 113

5/31/23, 12:23 PM Rowan County
Current Mailing Address Current Mailing Address
1800 Camden Road,Suite 10701 I
Charlotte,NC 28023
8.Recorded in Deed Book Number Page Number
1422 773
Part B
1.Person or Firm who are financially responsible for this land- Person or Firm who are financially responsible for this land-disturbing
disturbing activity activity
The Storage Yard,LLC
if
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
1800 Camden Road,Suite 10701
Charlotte,NC 28023
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Phone Number Phone Number
764-756-4635
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
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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
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Current Mailing Address Current Street Address
https:l/www.rowancountync,govIFormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 213

5131/23, 12:23 PM Rowan County
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).f agree to provide correctional information should there be any
change in the information provided herein.
Name Title or Authority
Jamie Yoxtheimer Jamie Yoxtheimer (Manager-Member)
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Signature Date
mmlddlyyyy 06/02/23
............................................................................................................................................................................................................................
[, J GtGE' �ty1lT ,a Notary Public of the County of L f4.clg a State of North Carolina,hereby certify that
MC f appeared personally befof a 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 day of .Juf�e- 202Z
Notary My commission expires
mmlddlYYYY I I- of - yG,ZCJ
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Notary Public, North Carolina
lredell County
Mmy Commission Expiresst NovemberOl,2025
Download a copy of the Erosion and Sedimentation Control Plan
Checklist(PDF)
https:/lwww.rowancountyno.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 3/3