NCC220944_FRO Submitted_20220307

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: Foster Apartments
2. Address of land —disturbing activity: 201 & 211 Foster Avenue
Charlotte, NC 28217
3. Approximate date land -disturbing activity will commence: Oct 1 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
Approximate acreage of land to be disturbed or uncovered:
6. List total site acreage: 0.997 AC
1.00AC
7. Landowners of Record (Use blank page to list additional owners):
Name: MSC FOSTER LLC
Address:725 PARK CENTER DR
MATTHEWS NC 28105
Telephone:
Fax:
(Area Code)
Email Address:
Signature:
Name:
Address: 725 PARK CENTER DR
MATTHEWS NC 28105
Telephone: Fax:
(Area Code)
Email Address:
Signature:
(Area Code)
(Area Code)
Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36030 Page 31 Book Page
Book Page
Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: MSC FOSTER LLC
Address: 725 Park Center Drive
Matthews, NC 28105
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: MMACONnmstarproperties.com
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone: Fax:
(Area Code)
Email Address:
(Area Code)
I 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.)
w `J L-&, % 6
Printed Name
Signature
I,
Of
certify that
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Title
5_ 1�) _."
10
Date
a Notary Public of the County
State of tjnLK 1L�1— hereby
personally
appeared before me this day and under oath acknowledge that this ffoV r!m was executed by him/her.
Witness my hand and notarial seal, this t ; day of�AC'� �s 20
Notary Signature:
My Commission ex)
•
��
AMANDA N1cDOWE�.t,
NOTARY PUBLIC
MECKLENBURG COUNTY, NC
t4 commission Expk" V2-2023
ENGINERtlNG & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.channeck.org
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