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HomeMy WebLinkAboutNCC232557_FRO Submitted_20230824 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 Parcel Ill Number 571 019 I. Project Name* McNeely Farms 2.Location of land-disturbing activity(Highway/Street)* Corner of Mooresville Rd&McNeely RD Latitude Longitude 35.625 -80.705 3.Approximate date land-disturbing activity will be commenced 5/1/2023 4.Purpose of development(residential,commercial,industrial,etc.) residential 5.Approximate acreage of land to be disturbed or uncovered* 9.599 6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number* activity* 704-400-6472 Jason Slagle *this information will be made available on the Rowan County Planning 8 Development website. Email Address iqcustomconstruction@gmail.com 7.Landowner of Record Landowner of Record Robert T. McNeely Trust Name Name Current Mailing Address Current Mailing Address 362 Cedar St Mooresville, NC 28115 t _� 8.Recorded in Deed Book Number Page Number 858 ---_�- 270 Part B 1.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this land- land-disturbing activity disturbing activity Redhead Land&Development, LLC Name of Person(s)or Firm(s) Name of Person(s)or Firm(s) Current Mailing Address Current Mailing Address 301 Watkins Farm Rd Woodleaf, NC 27054 Phone Number Phone Number 704-400-6472 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 Jason Slagle Owner Signature Date mm/dd/yyyy 3/ze/z3 04,.K) 3 Z)P-4-ed/6 I, ,a Notary Public of the County of 17-''''' I State of North Carolina, hereby certify that sc- s �,51 i e_ appeared 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 day of ,203,3 I Notary ‘‘‘ EFt L PA V commission expires Q 4.�..epo s�M••' d/yyyy 212Z 12 (o • Gv�- �rINoTAq to., — Seal ������•.?2g 2��%• `. Checklist 111 t t l Download a copy of the Erosion and Sedimentation Control Plan Checklist(PDF)