Loading...
HomeMy WebLinkAboutNCC241820_FRO Submitted_20240614 C RY A — 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: Walker Row PROJECT DEVELOPMENT PLAN#: 22-DP-771 6 PROJECT LOCATION: 0763597484 0763599415 0763691405 Property Tax ID#/PIN 413 S Walker Street Street Address - APPROXIMATE DATE OF PROJECT INITIATION: 10/1/2023 ACREAGE OF LAND TO BE DISTURBED: 2.15ac APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2 of the Financial Responsibility/Ownership(FR/O) Form.) PARK TOWNS 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.) PARK TOWNS LLC Name(Person or Firm) 100 E. Six Forks Rd. ste. 300 Street Address(No PO Box) Raleigh, NC 27609 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.carvnc.gov updated:04/2023 919-389-7595 Telephone Number Fax Number josh@envisionhomesnc.com 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.) JEREMY SPIVEY Name 100 E. Six Forks Rd. Ste. 300 Street Address(No PO Box) Raleigh, NC 27609 City State Zip 919-2912179 Telephone Number Fax Number jeremy@jsdevelopmentnc.com 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. Josh Swindell OR Financially Responsible Person Registered Agent Section 3 LANDOWNER OF RECORD: PARK TOWNS LLC Name(Person or Firm) 822861167 Property Tax ID#/PIN 100 E. Six Forks Rd. Ste. 300 Street Address(No PO Box) Raleigh, NC 27609 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. Josh Swindell member Name Title or Authority Signa re Date josh@envisionhomesnc.com 919-389-7595 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.) Josh Swindell member Type or Print Name Title or Authority Sign Lure Date C. t I, IA ale( e\cA a Yi5i'I ( tary Public of the County of VV edL_-'�--- , 4/State of North Carolina, hereby certifies that i DCIA SLAJ f Kit I t 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 :�- ) day of � f--- , cz)z�3 ANNALEE RICHARDSON Notary Public North Carolina Wake County Notary Public / My commission expires / 7 I 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