Land Development Division
(864) 467-4610
Resource Remediation Fund Certification
Date: ___________________________ Tax Map No.____________________________________
Project Name:_______________________________________ Permit No.___________________
I hereby certify that the project owner/operator/applicant has no known direct or indirect contractual,
business, financial, or familial relationship (“Relationship”) to a Resource Remediation Fund (RRF)
site where fund money is outstanding or for sites at which monies from the fund were spent. If a
relationship does exist, I understand that the county has the right to request the applicant to supply
additional specific information concerning any such affiliations.
I further understand that for sites at which monies from the fund are spent, an applicant with a
relationship to any Person Responsible for the Land Disturbing Activity on such Resource
Remediation Fund (RRF) site(s) or a relationship with a person who in the past has significantly
failed to comply with any provision of the stormwater ordinance or previously issued permit will not
be allowed to further participate in this program and no further review of a permit for land
disturbance activity will be conducted by the county or permit issued, until such time that all
Resource Remediation Fund (RRF) monies are repaid to the county in full by the applicant or other
such related person.
State of South Carolina
County of Greenville
_________________personally appears before me, the undersigned officer duly authorized by the
laws of South Carolina to administer oaths, and now on this _____day of _____________, in the
year of _______at _______pm/am of said day, being by me first duly sworn on his/her oath
affirmation.
_____________________________
(Signature of Affiant)
_____________________________
(Printed name of Affiant)
Sworn/affirmed to and subscribed before me
On this ______day of ________, in the year of ______
Personally known [ ] or Produced identification [ ]
Type of Identification produced_______________
________________________________________
(Signature of Notary Public)
________________________________________
(Printed name of Notary Public), Notary Public
Greenville County, South Carolina
My commission expires on: _________________
Revised: 12/2012
(Notary Seal)
County Square • 301 University Ridge • Suite 3900 •Greenville, SC 29601-3681 •Fax (864) 467-7518
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