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Home My WebLink AboutNCC222886_FRO Submitted_20220812Financial 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 1. Project Name Stoneglen Subdivision 2. Location of land -disturbing activity (Highway/Street) 0 W PEELER ST Latitude 3. Approximate date land -disturbing activity will be commenced 13/9/2022 Longitude Parcel ID Number 404 012 le 4. Purpose of development (residential, commercial, industrial, etc.) Residential 5. Approximate acreage of land to be disturbed or uncovered 12.77 6. Person to contact should sediment control issues arise during land -disturbing Cell Phone Number activity 626-316-2050 John Lambert l f Email Address john.lambert@prespro.com 7. Landowner of Record Landowner of Record J2 Land Investments, LLC Name Current Mailing Address 6549 Morehead Rd Harrisburg NC 28075 le Name Current Mailing Address 8. Recorded in Deed Book Number Page Number 1380 831 Part B 1. Person or Firm who are financially responsible for this land -disturbing activity J2 Land Investments, LLC s Name of Person(s) or Firm(s) Current Mailing Address 6549 Morehead Rd Harrisburg NC 28075 Person or Firm who are financially responsible for this land - disturbing activity e, Name of Person(s) or Firm(s) Current Mailing Address Phone Number Phone Number 704-453-2700 i 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 704-453-2700 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 Jon Devine Current Mailing Address Current Street Address 8410 Pit Stop Ct NW #150 Concord, NC 28027 Telephone Number Telephone Number 704 756 6608 X 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 he 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 John Lambert COO le Signature Date mm/dd/yyyy 3�9�ZZ ....................................................................................................................................................................................... e L Jac , a Notary Public of the County of _ State of North Carolina, hereby certify that cti!n LJM birrl— appeared personally before me this day, and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and seal of Notary, this C1 day of " 20 a Notary My commission expires mm/dd/YYYY �/a�i��o�� bl� l ��1lIIIlI/�� Seal Checklist Download a copy of the Erosion and Sedimentation Control Plan Checklist (PDF),