HomeMy WebLinkAboutNCC230773_FRO Submitted_20230321Financial 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
L Project Name
China Grove Apartments
Z. Location of land-disturbiog activity (laig,h►ti•aylStrect)
shue Road
l -ititude Longitude
3. Approximale date laud-disturlflug activity will he commenecd
12/1/2022
4. Purpose of development (residential, eommerrial, industrial, etc.)
complex
5. Approximate ncreage of lanai to be disturbed or uncovered
20
6. Person to contact should sediment control Issues arise during isutd-dtsturb£ng
activity
Craig Taylor
Email Addrass
com
Parcel 11) Number
117020
Cell Photse Number
336-708-4110
7. 1,audowner of Record
Shue L.l.0 etal--------------- _....___�.
Name__._ �..-----•—-__....._._....._....._._
Landowner of Iiecortl
1
Name
Current Nfaiiinir Address Cul•I'eltt Mailing Address
9541 Julian Park Ave, Suite 101, Huntersville, NC 28078E
8. RLevorded in Deed Book Number
parl B
1. Person or Kirin tied►o arc 13nalichilly responsible for this
lilnii-discllrllin;; aclieity
[FA Develop, t.l_C
Name of Person(s) or Firm(s) --- -- --
Current Mailing address
530 Eugene Ct. Greensboro, NC 27401
Phone N1Intber
336-7084110
Page slumber
i'erson or Firm who are fillallcially respoll%lble for this
lard-(J 4urbiwractivily
Iralg Ta r ace Press n pment
of Person(s) or Firms) _... _.__
(.nrrellV 11101hig Address
Plinlic titill) her
n. If fliv. 3. WAR1C.i:ll1Y Responsible Party is 11411 :1 residellt 11f Njl7'th (.arollim. give name and stiver addre55 of.) N1011.110I.0611S1
Ageal.
mill of Agcuf
Current 1.laiiing Address
Name of Agent
Clirrent A1.1111114 Addrrs'ti
Phone ?lumber Phone Number
b. 11' Me l"Inallcially Responsible 11tirly is a Prkrlljel-Nllil) or other IWOMM VllI,WginF ill hushmm kinder all assunieff umme, attach
it e(Off ()f file C4:rlifiVAIV GI'MISLIHIC41 W1111C. TJ'the (--jll;j1lCj:lllV ReSPOILAWO PAIIV is a Corporation, give file imme aura street
address of the Rqvisteved Aguit.
Nome of'Wgisk-s-ed Agent
(.:%Lrrt!w Alailing Address (" llrk'vW' Sfirect Addre%s
530 Eugene Cf. Greensboro, NC 27401
Telephone Nomber
336-708-4110
Telephtme Number
The above Wrol-I)Ialiull is true and Correct it) Ille toot of lily lolfiwiedg(t. and beliel'and was provided by me mukr unlit. (Tills
form must be Otmed 1)v file Fimindally Responsible Person if an individual (4- his 011 ii'llof an individual by
an offlur, director. partner: or rv-pisteretl mu'llt with 11"thol-ify to I.-mmile illstruilleuls I , 013, the IrimanciMly Responsible Person).
I WAITO 10 IWOvide Correctional illf(II-Ifilklioll S110111d there be -.lily elmiige In the informallon provided liei-ell).
Mime Thic or Authuriti
Craig Taylor Vice President of Development
Mile
Vq
1, 4:5Z r, " ' - Of (-W.1 LQe--4— State ofNorth Carolint,
' __���Wntary PlJb1lC Of MQ COL111(l
hereby certify that appeared persmially before me this day and be duly sivorn acknowleftud
01.1( IN, allove form wim Ill, Ill'in/lier. I'Villiess Illy hand alld mill (if Noary' this -4:Ln-+.tay 2 1),Z, p
Notary My collinflWom expires
mrn/dd/yyyy
Seal
Erika K. Larson
NOTARY PUBLIC
Daminad a copy of the Ermslon and Davidson Cowtr' No
Control Plan Chackilst (PLE) MY Commlaslon Expires April 08, 2028