NCC242689_FRO Submitted_20240830

Soil Erosion and Sethi)] attation Control
C•lit 1111 IIA.�C c)lIN It S
Financial Responsibility/Ownership Form
NOT REQUIRED TO BE CO,VPLETED FOR RESIDENTIAL LOT PERM IFS
PLEASE READ TILE FOLLOWIN GIN FORMATION:
I)This section must be signed in the presence of a Notary.
2)This fo rmmust be signed by the property owner if an individual.If-owned by a company or corporation,this form must be signed by an officer,
director,partner,attom 4,-m-fact,or other person with authority to execute mstni wcnts for the corporation and aeconpamed by a complete list of all
partners,managmg members and registered agents of the companyor corporation
3)This form must also be signed by the financially responsible party and NC agent(if applicable).Same provisions of aY 2 above apply.
4)If the landos mer and financially responsible patty arc different,the completion and srgnmg of this page shall serve as documentation
acknow ledgmg the landowner consents to and authorizes the financially responsible party to undertake the proposk land-disturbmg activity on the
landowncr's tracts)of land identified on this application
5)The information provided on this fonn is true and corract to the best of my knowledge and belief and was provided by me while under oath
6)All Land-Drsturbmg pern its arc \slid for up to (2)years from the date of issuance. if circumstances warrant, the permit may be extended for
(2) years per the conditions of the Chatham County Soil Erosion and Sedimentation Control Ordinance. Upon written notice, the Land-Disturbing
permit may be rooked for failure to comply with the Ordnance If the permit is revoked. all other permits and approvals arc withheld until
the props rty is once agam m compliance with Chatham County regulations. Also,upon written notice.a civil penalty(fine)can be instigated
against the property owl r and/or additional financially responsible party(if any)for viol lions of the Chatham County Soil Erosion and
Sedimentation Control Ordinance. This penalty is up to S5000.00 per violation per day and is assessed daily for every day the property is m violation.
Interfering with or hampering an inspection can result in a cis it penalty without written notice.
OW €ROF PRO F£RTV:
Name and T tic: Man Yu and Chaohut Qi
Company(if applicable):
Signature 4t-Tta-41F
FINANCIALLY RESPONSIBLE PARTY (appli able only if different from property owner):
Name and T ilc:
- -
Company:Signature:
NO RF'H CARO IINA AG FNT (if any):
Namcand T ilc:
C am pany: —
Signature: _
** l� }} /
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LIL.1 L. pc.7 ,a Naary Public of Q Canty in the state
of 4, -. (as—z (, ikQ 1 do hereby certify thatt i, '- C L 1 . : & I.personally
appeared before me this day and under oath acknowledged reading the information above and acknowledged that the
above form was executed by him or her.
Witness my hand and official seal,this the ct 1 ay of e =20, .a+t"ii"rii'in,,,
A2L _ i
`���,,, ,Ul N Dq
Notary Public -D •06� -4% c
My cum m ssion expires L? 6/12"2,0 (SEAL) IT; o •
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