NCC241211_FRO Submitted_20240419

CARY
NORTH CAROLINA —
Stormwater Division
FINANCIAL RESPONSIBILITY - OWNERSHIP FORM
No person may initiate any land-disturbing activity covered by Cary's Sedimentation and Erosion Control
Ordinance before completing and filing this form with the Cary Stormwater Division. Indicate N/A if a
question is not applicable.
Section 1
PROJECT NAME: Green Level Trail (Grading Permit)
PROJECT DEVELOPMENT PLAN #: 21-DP-4436-A
PROJECT LOCATION: 4216 Green Level West Road
0723164919;0723271438
Property Tax ID#/P/N
Street Address
APPROXIMATE DATE OF PROJECT INITIATION: 5/01/2023
ACREAGE OF LAND TO BE DISTURBED: 19.74 acres
APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2
of the Financial Responsibility/Ownership (FR/O) Form.)
Erica Leatham c/o M/I Homes of Raleigh, LLC
Name(Person or Firm)
Section 2
PERSON(S) OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY:
(If out of state, a registered agent in North Carolina must be used.)
Erica Leatham c/o M/I Homes of Raleigh, LLC
Name(Person or Firm)
1511 Sunday Drive, Ste 100
Street Address(No PO Box)
Raleigh, NC 27607
City State Zip
316 North Academy Street, Cary, NC 27513 Cali/ PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
updated:04/2023

[phone]
Telephone Number
[phone]
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
(If out of state, a registered agent in North Carolina must be used.)
Corporation Service Company
Name
2626 Glenwood Avenue, Ste 550
Street Address(No PO Box)
Raleigh, NC 27608
City State Zip
[phone]
Telephone Number
[phone]
Fax Number
[e-mail]
E-Mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation. Please indicate your preference below.
Financially Responsible Person Registered Agent
Erica Leatham OR
Section 3
LANDOWNER OF RECORD:
M/I Homes of Raleigh, LLC
Name(Person or Firm)
0723164919
Property Tax ID#/PIN
1511 Sunday Drive, Ste 100
street Andress(No F'v box)
Raleigh, NC 27607
City State Zip
Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
Page 2 of 3 updated: 04/2023

STATEMENT OF LANDOWNER CONSENT:
In accordance with NCGS 113A-54.1(a), I hereby declare that I am the owner or legally authorized
representative of the owner of the property described above and provide my consent for the applicant
cited in Section 1 above to submit an erosion control plan to the Town of Cary Stormwater Division and to
conduct the planned land-disturbing activities on the property listed in Section 1 above
Erica Leatham VP of Land for M/I Homes of Raleigh, LLC
Name Title or Authority
December 12, 2023
Signature Date
eleathammihomes.com [phone]
Email Telephone Number
THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided
by me while under oath. (This form must be signed by the financially responsible person, if an
individual or by an officer, director, partner, attorney-in-fact, or other person with authority to
execute instruments for the financially responsible person if not an individual.)
Erica Leatham VP of Land for M/I Homes of Raleigh, LLC
Type or rint me Title or Authority
December 12, 2023
Signature Date
I, Sara S Clifton, a Notary Public of the County of Wake, State of North Carolina, hereby certifies
that Erica Leatham personally appeared before me this day and under oath acknowledged that
the above form was executed by him/her.
Witness my hand and notarial seal,this 12th day of December, 2023
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Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
Page 3 of 3 updated: 04/2023