NCC223719_FRO Submitted_20221102

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section 6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this
form with the City of Charlotte Engineering and Property Management Department, Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility party will be on record as the party to
accept any Notices of Violation or related documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. If the financially responsible party is out of State, a North Carolina agent must be assigned.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken:
2. Address of land --disturbing activity:
Eastfield Station
6106 Hucks Rd, Charlotte, NC 28269
3. Approximate date land -disturbing activity will commence: 09
F.
5
Month
Purpose of Development (Residential, Commercial, Industrial, etc.):
Approximate acreage of land to be disturbed or uncovered: 36.74 ae
6. List total site acreage:
50.03 ac
7. Landowners of Record (Use blank page to list additional owners):
Name: GS Eastfield, LP
Address: 521 E Morehead St, Ste 400
Charlotte, NC 28202
Telephone:
704-840-7394
Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature:
Name:
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
01 2022
Day Year
Residential
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 37374 Page
Book 37374 Page
270
266
Book Page
Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: GS Eastfield, LP
Address: 521 E Morehead St, Ste 400
Charlotte, NC 28202
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
while under oath. (This form must be signed by the financially responsible person if an individual or by an
officer, director, partner, attorney -in -fact, or other person with authority to execute instruments for the
financially responsible company or entity, if not an individual.)
Josh Glover
Name
Vice President
Title
8/1 /22
Date
I P� V-.,y CA—,'> ca.r . a Notary Public of the County
of i�LclLl l�u c S State of Noc tL. Ci v\cl hereby
certify that
C'ta,, ,It
appeared before me this day and under oath acknowledge that this form was executed by him/her.
personally
Witness my hand and notarial seal, this day of _A n S 20 2 z-
Notary Signature. -
My Commission expires: e- r 2 0 20ZC�
Andrew Phelan
NOTARY PUBLIC
Mecklenburg County, NC
My Commission Expires October 20, 2026
•
CtLARLOTTF...
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.char-meck.org
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