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HomeMy WebLinkAboutNCC241565_FRO Submitted_20240522 AM Town of Cary \ ram, , Stormwater Division 316 N.Academy St. Cary,NC 27513 FINANCIAL RESPONSIBILITY -OWNERSHIP FORM No person may initiate any land-disturbing activity covered by the Town of Cary Sedimentation and Erosion Control Ordinance before completing and filing this form with the Town of Cary Stormwater Division. Indicate N/A if a question is not applicable. PROJECT NAME Cloudberry Commons Townhomes PROJECT DEVELOPMENT PLAN # 22-DP-7742 PROJECT LOCATION 7436 Roberts Road APPROXIMATE DATE OF PROJECT INITIATION April 29, 2024 ACREAGE OF LAND TO BE DISTURBED 5.2 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.) 121 Lenox LLC/Smultron LP Name(Person or Firm) 188 Mels Meadows Drive Street Address(No PO Box) —City Varina, NC 27526 City State Zip 201-317-3793;201-306-2389 Telephone Number Fax Number propertyavatars(cagmaii.com E-Mail Address REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE: Britt Nylund Name 188 Mels Meadows Drive Street Address(No PO Box) _Fupuay Varina, NC 27526 City State Zip Town of Cary 316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005 Tel(919)469-4030 Form updated 02,17/2022 201-317-3793 Telephone Number Fax Number pro pertyevatars( (mail.corn 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. IvnC Financially Rcaponaible Pcr on OR Rcgiatcrcd Agcnt 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.) cype Britt nd or riot N - Sign u Managing Member 121 Lenox LLC General Partner of Smultron LP Title orA' rity 6./ Date North Carolina Vv County 177. , ` , a Notary Public of the County of WP.9-4siZZV-T-- , North Carolina, do hereby certify that7-.``C1"TO personally appeared before me this day and under oath acknowledged that the above form was executed by him/her.Witness my hand and notari-I seal, this ' day of A L- , ,,, s MORi,41,, - / •• Q`- ''••s 1AR • : o Y Notary ubl ; ' O My commissio -xpi -s y• �•, pUB�\G ,'2 % FTT CO,,,�`'. Town o_f Cary 316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005 Tel(919)469-4030 Farm updated 02/17/2022 page 2