NCC240244_FRO Submitted_20240209

►\VA\XIIIIA\��\ EROSION CONTROL FINANCIAL RESPONSIBILITY FORM.
No person may initiate any land-disturbing activity as defined in Chapter 159 of the Town of
Waxhaw Town Code prior to completion of this form, and an applicable and acceptable erosion
and sedimentation control plan has been approved by the Development Services Department.
(Please type or print)
Part I
Name of Project: Village of Waxhaw
Address where land disturbing activity will take place: 5401 Waxhaw Marvin Rd
Approximate date disturbing activity will commence:
Purpose of development(residential, commercial, industrial, etc.): Residential
Total acreage of land to be disturbed or uncovered: 7.3 Acres
Amount of fee enclosed(show calculation): $1,320
$500 first ac+ $100/ac for each additional acre + 10%Technology
($500 + ($100x7)) x 1.1 =$1,320
Agent to contact should sediment control issues arise during land disturbing activity:
Name: Mark Henninger
Address: 6701 Carmel Rd, Suite 425
State: NC Zip code: 28226
Phone: [phone] Email:Mark.HenningerPlennar.com
Landowner(s):
Name: CalAtlantic Group, Inc.
Address: 6701 Carmel Rd, Suite 425
State: NC Zip code:28226
Phone: [phone] Email: [e-mail]
Name:
Address:
State: Zip code:
Phone: Email:
Indicate Book and Page where deed of the property where land disturbing activity will take place
is recorded:
Book: 6782 Page: 448
Book: 6782 Page: 451
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MAXI-HAW lI EROSION CONTROL FINANCIAL RESPONSIBILITY FORM
Book: Page:
Book: Page:
Indicate tax map and parcel number of the property where land disturbing activity will take place
is recorded:
Tax Map: N/A Parcel: 05138026
Tax Map: N/A Parcel: 05138027
Tax Map: Parcel:
Tax Map: Parcel:
Part II
Person(s) or firm(s)who are financially responsible for the land disturbing activity:
Name: Lennar Carolinas, LLC (Formerly CalAtlantic Group, Inc.)
Address: 6701 Carmel Rd, Suite 425
State: NC Zip code:28226
Phone: [phone] Email: Mark.Henninger(cr�lennar.com
Name:
Address:
State: Zip code:
Phone: Email:
Name:
Address:
State: Zip code:
Phone: Email:
If the financially responsible party is not a resident of North Carolina, give the name and address of a
North Carolina Agent:
Name:
Address:
State: Zip code:
Phone: Email:
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 address of the registered agent.
Name: Mark Henninger
Address: 6701 Carmel Rd, Suite 425
State: NC Zip code: 28226
Phone: [phone] Email: Mark.Henninger(cr�lennar.com
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‘i1VAXUAW EROSION CONTROL FINANCIAL RESPONSIBILITY FORM
L I IN5
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)
Name: Mark Henninger a----�
Address: 6701 Carmel Rd, Suite 425
State: NC Zip code: 28226
Phone: [phone] Email: Mark.Henninger(aennar.com
I, /K 1 **( G- 64es a Notary Public of cr)/J
County, North Carolina, do hereby certify that /140,' fleArbfie personally
appeared before me this day, and being duly sworn, stated that in his presence
(signed) (acknowledged the execution of) the foregoing instrument.
Witness my hand and official seal, this the a2,2 day of J-/,L,70_, 20_13
(Official Seal)
Notary Public
My commission expires , 20 2-?
KATHLEEN G. JONES
NOTARY PUBLIC
Union County
North Carolina
My Commission Expires May 4,2027
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