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HomeMy WebLinkAboutNCC230376_FRO Submitted (2)_20230213CITY 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 0 Name of Project Blue Sky Meadows (Phase 4 & 5) Address where land disturbing activity will take place 2219 Concord Avenue, Monroe, NC 28110 3. Approximate date disturbing activity will commence 01 1 15 y 2023 4. Purpose of development (residential, commercial, industrial, etc.) Residential 5. Total acreage of land to be disturbed or tine :oei ed 44 acres 6. 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.) $4800 7. Agent to contact should sediment control issues arise during land disturbing activity Name Johnny Evans Phone 704-216-1657 S. Landowner(s) of Record (use blank page to list additional owners) Name Century Communities Southeast LLC Name Mailing Address 7401 Carmel Executive Park Mailing Address Drive, Suite 310, Charlotte NC 28226 Street Address 7401 Carmel Executive Park Street Address Drive, Suite 310, Charlotte NC 28226 Phone 704-216-1657 Phone 9. Indicate Book and Page where deed of the property where land disturbing activity will take place is recorded (use blank page to list additional owners) Book 8313 Book Page 869 Page l0. Tax Map Parcel Number where land disturbing activity will take place 09 __ 216 __ 042 07-18 Permits. Checklists, and Fomis Division 07 CITY OF MONROE STANDARD SPECIFICATIONS AND DETAIL MANUAL Part II 1. Person(s) or firm(s) who are financially responsible for this land disturbing activity (use blank page to list additional owners) Name Century Communities Southeast LLC Name vlailin- Address7401 rmg? Mailing Address Drive, Suite 310, Charlotte NC 28226 Street Address-1 60 M}ne Lake Cpff_$ i�.f�20o Street Address Raleigh, NC 27615 Phone 704-216-1657 Phone Fax Fax 3. 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 3 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 Parry 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 The above information is true and correct to the best of my knowledge and belief and "as 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 Johnny Evans Title Land Development Project Manager Signature ,�;W� Date LQ 1j2q � 94OZ2 • �` a Notary Public of the County of .State of North Carolina. hereby certify that 3Phnr_"j1,]_ appeared personally before me this day a d being dily sHom acknowledged that the above form was executed by him. 'Vv ��ii�FE�F h ie �ntarialseal. this 1` da! of -- Cyr .b - 262.'7— �` •••:.csfdn 1 1. ARYp^w' _ (Notan) =U` My commission expires �`� 2 �.J Uary�? ',l•, 07-19 Permits, Checklists, and Forms Division 07 +�!!!l7r11111 ttt''1