NCC230909_FRO Submitted_20230403

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
F0 41
inancial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
]. Project name,: Wells Fargo CIC Parking Expansion
2. Address of land —disturbing activity: 6901 IBM Drive, Charlotte, NC 28262
3. Approximate date land -disturbing activity will commence; April 1st 2023
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Commercial
5. Total acreage of land to be disturbed or uncovered,.: 12996 AC
6. List total site acreage: 155.24 AC
7. Landowners of Record (attach accompanied page to list
the person(s) or firm(s) financially responsible as listed
by the landowner of record or their authorized agent is r
additional owners). If the landowner of record
in Part B, item 1, a separate letter of consent si
equired:
Name: Wells Fargo Bank, N.A.
Address: 1525 W. VVT Harris Blvd, Charlotte, NC 28262
Telephone: [phone] Fax:
(Area Code)
Email Address: Christopher. hale2awel Isfarq o-com
(Area Code)
is not
gned
Name: Christopher C. Hale, ConstructoniProject Manager, Wells Fargo Bank, N.A.
Address
11 1525 W. WT Harris Blvd, Charlotte, NC 282620=0
Telephone:- [phone] Fax:
(Area Code) (Area Code)
Email Address: christopher,,hale2@welisfargo,,com
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 07822 Page go Book Page
NEENEEMEMEMMMMM�
Book Page Book Page
Page I

Continue -Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity ote: If rhefrnancia/lyresponsible
person(s) or frrnr(s) has an out -of -stale address, a Noteth Carolina agent nt:rsl be designated in item 2 below):
Person or Film: Wells Fargo Bank, N.A. HChristopher Hale
Address:. 1525 W.VVT Harri
s Blvd, Charlotte,, NC 28262
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address:
2,w If the Financially Responsible Party j*s not a resident of North Caro
designated North Carolina agent:
Person or Firm:
Address:
lina, give name and street address of the
Telephone:* Fax:
(Area Code) (Area Code)
Email Address*.
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.)
Christopher C. Hale
Prime Name �
Construction PM, Wells Fargo Bank, N.A.
Title
Signature'
t14A �jij�Otr
of VEA&O State of Yc/f % Z�fo�A
cerlifythat k1,s#11U151UPHe[ umv
appeared before me this day and under oath acknowledge that 1hisform was executed by him/her.
Witness my hand and nota�rral sea
)L
------- MEL*
Date
a Notary Public of the County
Notary Signature:
My Commission expires:
Rev 09/2021
i ME F..1 �
10 th is '2 of
.3 /;0;)l
charlottenc.gov
Storm Water Services — Land Development
hereby
ersonally
Brian Barber
Notary Public
State of Florida
My Commission Expires 04/13/2023
Commission No. GG 320388
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
htt o://charlottenc. aov/d eve lopm entcenter
Page 2