NCC220952_FRO Submitted_20220307

.�,�.
e
Town of Huntersville
Soil Erosion & Sedimentation Control Ordinance
NORTH CAROLENA Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By filing this form, the parties are not relieved from any other permits that may be
required for the Project. 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: Hambri ht Industrial LLC
2. Address of land -disturbing activity: 10701 Hambri ht Rd. Huntersville NC 28078
3. Approximate date land -disturbing activity will commence: Feb 28 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Industrial
5. Approximate acreage of land to be disturbed or uncovered: 19.53 AC
6. Total site acreage: 24.816 AC
7. Landowners of record (use blank pages to list additional owners as necessary)
Owner #1 Name: Hambri ht Industrial LLC
Address: 440 S. Church St. Ste. 800 Charlotte, NC 28202
Telephone: [phone]
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone:
Fax: [phone]
Fax:
Email Address:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book Page
Book Page
Book Page

Financial Responsibility/Ownership Form - Continued
PART B
1. Person(s) or firms) financially responsible for this land -disturbing activity:
Persons or Firm: Hambright Industrial LLC
Address: 440 S. Church St. Ste. 800 Charlotte, NC 28202
Telephone.
704-714-4515
Email Address: [e-mail]
Fax: [phone]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: C. Walker Collier III
3. Address: 440 S. Church St. Ste. 800 Charlotte, NC 28202
Telephone:
704-714-4515 Fax: [phone]
4. Email Address: [e-mail]
5. 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 is 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)
_ C. Walker Collier III President
Printed Name Title
Signature Date
Public of the County of
certify that
, a Notary
State of /Vcy- t_I n r
APA hereby
personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notqlrial sea[, this day of / 'dk .20
Notary Signature:
My Commission Expires: (40);-er
Town of Huntersville
PO Box 664
105 Gilead Rd., Ste 300
Huntersville, NC 28070