NCC222934_FRO Submitted_20220816

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
07.06 EROSION CONTROL FORMS AND CHECKLISTS
07.06.01 EROSION CONTROL FINANCIAL RESPONSIBILITY FORM
No person may initiate any land -disturbing activity as defined in Chapter 158 of the Monroe City Code prior to
completion of this form, and an applicable and acceptable erosion and sedimentation control plan has been approved by
the City of Monroe Engineering Department, (Please type or print)
Part I
1. Name of Project Timber Ridge Subdivision (Lots 1-25)
2. Address where land disturbing activity will take place_ 2218 Waverly Dr. Lots 1-25
3.
4.
5.
6.
7.
8.
9
10.
Approximate date disturbing activity will commence 06 / 01 2022
Purpose of development (residential, commercial, industrial, etc.) Residential
Total acreage of land to be disturbed or uncovered 12.66
Amount of fee enclosed (fee will be the amount of current policies per acre multiplied by the total number
of acres or any part of an acre from number 5, i.e. 7.28 acres equals 8 acres.)- $500 + (100*121= $1,700
Agent to contact should sediment control issues arise during land disturbing activity
Name Keith Fenn Phone [phone]
Landowner(s) of Record (use blank page to list additional owners)
Name Carolina Development Services, LLC Name
Mailing Address 2627 Brekonridge Centre Dr. Mailing Address_
Monroe, NC 28110
Street Address_2627 Brekonridge Centre Dr. Street Address
Monroe, NC 28110
Phone [phone] phone
Fax Fax
Indicate Book and Page where deed of the property where land disturbing activity will take place is recorded
(use blank page to list additional owners)
Book 7725 Book
Page 639 Page
Tax Map Parcel Number where land disturbing activity will take place 09 __ 286 __ 061
07-18 Permits, Checklists, and Forms
Division 07

CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL
Part II
Person(s) or firm(s) who are financially responsible for this land disturbing activity (use blank page to list
additional owners)
Name True Homes USA Names
Mailing Address 2649 Brekonridge Centre Dr
Monore, NC 28110
Street Address 2649 Brekonridge Centre Dr.
Monroe, NC 28110
Phone [phone]
Mailing Address
Street Address
Phone
2. A) If the Financially Responsible Party is not a resident of North Carolina, give name and address of a North
Carolina Agent
Name of Registered Agent
Mailing Address
Street address
City State
Zip
Phone Email Fax
13) 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
Mailing Address
Street address City State Zip
Phone Email Fax
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath. I agree to provide corrected information should there be any change in the information provided
herein. (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)
Type or Print Name 44,'i 1—W f t' T✓V Title
Signature' Date _�/ 1�2
Notary Public of the County of _ VW XZ04 _, State ol'North Carolina,
appeared personally before me this day and being dily sworn acknowledged
that the above fonn was executed by him.
Witness my hand and notarial seal, this day of 2022—
.wutiA�tuJ�r.tR,0
N/ .SEAL qV oA/
�
c
ypTARYS(Notary)
my Comm. Exp. = My commission expires YJ �� v Z
ivsrzo22 - 07-19 Permits, Checklists, and Forms
'°UBl.1G 49
- Division 07
G
yi� 011t,�
Nc .
""1111rllR4 Olk