NCC223443_FRO Submitted_20221004

HOUR
Mecklenburg County Soil Erosion and
F ' Sedimentation Control Ordinance
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Financial Responsibility/Ownership Form
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No person shall initiate any land -disturbing activity covered by Section 6 of the Mecklenburg
County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Environmental
Services. The financially responsible party will be on record as the party to accept any Notices
of Violation or related documents for any non-compliance with the above Ordinances. 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:
River Road
Towns at w Rocky
2. Address of land -disturbing activity: 1419 Rocky River Rd
3. Approximate date land -disturbing activity will commence: November 5 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
3.57
5 Approximate acreage of land to be disturbed or uncovered:
6. Total site acreage: 4.03
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner #1 Name:Ki zer Homes, TLC
Address: 215 North Pine Street, Unit 3026, Charlotte NC 28202
Telephone: [phone]
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone:
Email Address:
Fax: N/A
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary):
Book 35720 Page 344 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial ltesl'aonsibilitylOis,ner,hip Form
PARTII
1. Persott(s) or tirni(s) financially responsible for this land-ifisturbing activity:
Person or Firm: Kinger Homes LLC
Address: 215 North Pine Street, Unit 3026. Charlotte NC 28202
Ttlephotle: 704-550-1652 _ Fax: N/A
Email Address. [e-mail]
2. North Carolina agent for the or tine who is fituinciallt responsible:
Person or Firm; —
Address:
Telephone;
Email Address:
l-ax:
3. The above infonnation 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 thi! financially responsible
petson if an individual or by yin officer, director. partner. attorney-in-i'act. or other person
with authority to execute instrurnetits for the iilttmcially responsible company or entity, if not
till individual,)
Dhanesh Kumar
prince Nflr
5ienal'i rc
Managing Director of Kinger Homes
Title
05/05/2022
Date
1, PO D qqy-(- " ��g> .`� --� , a Notary Public of the
County of C-p/lleyn � � �► State of AA , hereby
certifv that _Dd�m�-S� K�'`'Y pvrsonally appeared
Wort; me this day and tinder oath ackno,vIcdged that this fonn irras executed by him?her.
Wittiess my hand and notar i seal. INS 0 SS day of � . 20
Notary Signature;:
1•ty Cummiasiotl cx[�ires; L5% 1 3 i �b a f_ QO.•�oti
Nlecktenburg County Laud Usa .md EnYironmmial Scivices Aocne
2145 Suttle A%v.
Charlotte. NC: 28208.5237
Phone (980) 3 t4-3234
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