NCC220948_FRO Submitted_20220304

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity coi-ered 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
fonn i ith the CAN of Charlotte Engineering and Property Management Department, Land DeN elopment Services Dii ision
or Mecklenburg County Land Development Senices. The financial responsibility party «-ill be on record as the part~_ � to
accept airy Notices of Violation or related documents for any non-compliance of the Cite 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.
Savona Mill Renovation
2. Address of land —disturbing activity: 528 S. Turner Ave., Charlotte, NC 28208
3. Approximate date land -disturbing activity will commence: September 1 2021
Month DaN Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Commercial
5. Approximate acreage of land to be disturbed or uncovered: 29.5
6. List total site acreage: 27.53
7. Landowners of Record (Use blank page to list additional owners):
Name: Savona Resi Project LLC (C/O Portman Holdings LLC)
Address: 303 Peachtree Center Ave., Suite 575, Atlanta, GA 30303
R.
Telephone: [phone]
Email Address:
Signature:
Name:
Address:
Telephone:_
Email Address:
(Area Code)
Cott@portmanhold
(Area Code)
com
Fax:
Fax:
(Area Code)
(Area Code)
Signature:
Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 35433 Page 555 Book Page
Book 35433 Page 566
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: Savona Resi Project LLC C/O Portman Holdings LLC)
Address: 303 Peachtree Center Ave. Suite 575 Atlanta GA 30303
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: Savona Resi Project LLC (C/O Portman Holdings LLC
Address: 160 Mine Lake Ct, Suite 200, Raleigh, NC 27615
Telephone: [phone]
(Area Code)
Email Address: [e-mail]
(Area Code)
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.)
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Printed Name
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Signature
Title
b &Z 7-
Date
i oa h KA Si nllf?w n , a Notary Public of the County
of r1 State of Geo ✓�%O hereby
certify that _ 14 0 Swk* personally
appeared before me this day and tinder oath acknowledge that this form was executed by him 'her.
Witness my hand and notarial seal, this 2y cA day of Ju h e. 120 2
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Notary Signature:
My Commission expires:
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ENGINEERING & PROPERTY
MANAGEMENT
J EXPIRES S
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GEORGrA
APRIL 3o 2024
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Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpennits.charmeek.org
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