NCC222116_FRO Submitted_20220614

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: CARM EL 7 ESTATES
2. Address of land -disturbing activity: 3800 WIN DWOOD CIRCLE, CHARLOTTE, NC 28226
3. Approx it hate date land -disturbing activity will commence:
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): RESIDENTIAL
5. Approximate acreage of land to be disturbed or uncovered:
6. List total site acreage: 2.38
.;
7. Landowners of Record (Use blank page to list additional owners):
Name: TPM PROPERTIES LP
Address:3816 MOORELANI3 FARMS ROAD, CHARLOTTE, NC 28226
Year
Telephone: 7& -.3 & 1 - D 0 15 Fax:
(Area Code) (Area Code)
Email Address:�wf fJM c �^��e . en► -
Signature, � A"r �---"� --
7'
Name:
Address:
Telephone:
(Area Code)
Email Address:
Signature: _-
Pax.
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 34454 Page 846 Book Page
Book 32521 Page 233 Book Page
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Continue - Financial Responsibility/Ownership Form
PART S
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: SINACORI BUILDERS
Address: 10100 PARK CEDAR DR, #166, CHARLOTTE, NC 26210
Telephone: [phone]
(Area Code)
Email Address: REECECO
NACORIBUILDERS.COM
ax:
(Area Code)
North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: 7WM ?&gW CC We 5 L VO
Address: G r
Telephone: ?D it ---96d - 3QA Fax:
(Area Code) 1 (Area Code)
Email Address: r�r T,D1q C Acz,-As Yle . C40_A'\� _.._-.-
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 -£act, or other person with authority to execute instruments for the
financially responsible company or entity, if not an individual.)
IF�-� SL+s�4caQ-�
--••-•-- Title
bt. ¢ .'�•1
S na a Date
f, . a Notary Public of the County
State o I lac .Lf 1 �� y
tha
peg sonally
appeared before me this day and tinder oath acknowledge that this farm was executed by himlher.
Witness my hand a axial seat, this � • day o � L� .t . 20_�
Notary Signatur r>>-. ter _. Z`L . -. _--•-•
My Commission expires:
o,Da A, IV. ri
rotary
t'U0r- -N
op
.0 die �BCktenbusSo ;Q
f `f col f 1 o rlk ► 4�
MRA)M.
EH47NEERFNG & PROPERTY
MAMAGEMEM .
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 2 8202- 2844
Telephone: [phone] Fax: [phone]
http://Iandpennits.channeck.org
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