NCC215915_FRO Submitted_20211026

P N
Mecklenburg County Soil Erosion and
{ Sedimentation Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity covered by Section 6 of the Mecklenburg
County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Environmental
Services. The financially responsible party will be on record as the party to accept any Notices
of Violation or related documents for any non-compliance with the above Ordinances. 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: Meadow Vista
2. Address of land -disturbing activity: 4851 Wilgrove-Mint Hill Road
3. Approximate date land -disturbing activity will commence: November 2021
Month Day
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered. 25.5 AC
6. Total site acreage: 35.328 AC
7
Landowners of record (use blank pages to list additional owners as necessary):
Owner #1 Name: Taylor Morrison of Carolinas, Inc.
Address: 11405 Community House Road, Suite 150, Charlotte, NC 28277
Telephone:
Email Address:
Owner #2 Name:
Address:
Telephone
Email Address:
Fax:
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary):
Book 35853 Page
738
- - g
Book Page
s e,
(continue on back or separate pages as necessary)
Page
Page
Year
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Taylor Morrison Homes
Address: 11405 N. Community House Road, Suite 150, Charlotte, NC 28277
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone: Fax:
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.)
q Ke r V; / re.S
Printed Name Title
f 12/2 3 / 2,?�o
Signature Date
I, N I VA4Sh R_ ' PaT-0— 1 , a Notary Public of the
Countyof jy)-eLk 1vtbvut-v� ,Stateof tjv�r4-t\ CtVu uo� hereby
certify that Ak a o 14o r• t.Q y _ personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notari�lseal,-this z '23 day of , 20 2-LD
Notary Signature:
My Commission expires:
`aa.,-
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Mecklenburg County Land Use and Environmental Services Agency - K c .
2145 Suttle Ave. f
Charlotte, NC 28208-5237 �B�-� .•�
Phone [phone]�BI�RC C❑�CR ��
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