NCC241903_FRO Submitted_20240621

9/20/22,9:31 AM Rowan County
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 ID Number
064 0030100001 & 064
0030100002
1.Project Name
Courtyards at Stoneridge
2.Location of land-disturbing activity(Highway/Street)
Stoneridge Drive
Latitude Longitude
35.635926 -80.467499
3.Approximate date land-disturbing activity will be commenced
12/1/2022
4.Purpose of development(residential,commercial,industrial,etc.)
Residential
5.Approximate acreage of land to be disturbed or uncovered
21
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number
activity 17043639760
Greg Williams
r
Email Address
[e-mail]
hops://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 1/3

9/20/22,9:31 AM Rowan County
7.Landowner of Record Landowner of Record
James Bonds
Name Name
Current Mailing Address Current Mailing Address
2250 Summer Oak Drive, Salisbury, NC 28146
8.Recorded in Deed Book Number Page Number
1352 407
Part B
I.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this
land-disturbing activity land-disturbing activity
Fairview Development C , Grokr t'G
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
2805 Walkup Ave, Monroe, NC 28105
Phone Number Phone Number
7043639760
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
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 2/3

9/20/22,9:31 AM Rowan County
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
Greg Williams
Current Mailing Address Current Street Address
2805 Walkup Ave, Monroe, NC 28105
Telephone Number Telephone Number
7043639760
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
6%)' S DJ 111 um
plcw, bcp
Signature Date
0 II ,, ,, mm/dd/YYYY Si', 2 I 23 ZZ
Aies
•
I, '&'1c '5 I-0cne tl\ O,ha Notary Public of the County of LkY � State of North Carolina,
hereby certify that dr (1.iMiCtre'ppeared personally before me this day and being dul sworn acknowledged
that the above form was executed lit, him/her.Witness my hand and seal of Notary,this al day of N.m ,200..a`'
Notary My commission expires
(C2eVA) ,o mm/dd/YYYY ���llll an,maws
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Seal
Checklist �•'•,' �'�' G
Download a copy of the Erosion and Sedimentation 0
Control Plan Checklist(PDF)
https.//www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgressID= 313