NCC223092_FRO Submitted_20220902

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: Mallard Creek Towns
2. Address of land —disturbing activity: 7208 Mallard Creek Rd., Charlotte, NC 28262
Parcels 04705313, 04705323, 04705303, 04705307
3. Approximate date land -disturbing activity will commence:_ 08 01 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.):. Residential
5. Approximate acreage of land to be disturbed or uncovered:_ 16.0
6. List total site acreage:_ 21.28
7. Landowners of Recorrtl (Use blark page to list additional owners):
Name: Landowners of Record on next page (Under contract with D.R. Horton)
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
Name: George Bartley Carroll (D.R. Horton, Inc.)
Address: 8001 Arrowridge Boulevard, Charlotte NC 28273
Telephone- (704) 620 - 7373 Fax.
(Area Code)
Email Address;, [e-mail]
(Area Code)
8. Indicate Book arid Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 33065 Page - 104
Book 10844 Page - 640
Book_ 26330 _ Page
861
Book_ 22101 page 204
Page 1

Landowners of Record
Name: _ 04705303: James W Garrison
Address: 7208 Mallard Creek Rd. Charlotte, NC 28262
Telephone:
Email Address:
Signature:
Name: 04705323: James W Garrison
Address: 7208 Mallard Creek Rd. Charlotte, NC 28262
Telephone:
Email Address:
Signature:
Name: 04705307: James K Alexander
Address: 7100 Mallard Creek Rd. Charlotte, NC 28262
TelephonO:
Email Address:
Signature: _
Name: 04705313: Eugene E III Merchant
Address: 3210 Kendale Ave NW Charlotte, NC 28262
Telephone:
Email Address:
Signature:

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: George Bartley Carroll (D.R. Horton, Inc.)
Address: 8001 Arrowrid a Blvd.
Charlotte, NC 28273
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: CT Corp.
Address: 150 Fayetteville Street, Box 1001, Raleigh, NC 27601-2957
Telephone:- [phone] Fax:
(Area Code) (Area Code)
Email Address: info ctadvantage.com
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
nfinancially responsible company or entity, if not an individual.)
/t t, a ��,, l % 01'a, J .� if/I',(% CS /AI � Q c r
Printed Name le Title
Signature"T Date
I, F06 r 0- �" a Notary Public of the County
of Q C� State of a r 1' l l.f� h ov hereby
certify that Bc� Cr'rlm1 personally
appeared before me Wzis day and under oath acknowledge that thisform was executed by him/her.
Witness my hand and notarial seal, this eLd day of J'"r� , 20 22
Notary Signature: -
My Commission exp'
LOGAN F. CREECH
Notary Public, North Carolina
Mecklenburg County
My Commission Expires
March 03, 2027
CHARLOTTE -
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.charineek.org
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