NCC230408_FRO Submitted_20230214

N6UR°�
Mecklenburg County Soil Erosion and
Sedimentation Control Ordinance
Rr„ Aa°v Financial Responsibility/Ownership Form
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
Project where land -disturbing activity is to be undertaken: Coventry Townhomes
2. Address of land -disturbing activity:
12610 Rock Hill -Pineville Road
3. Approximate date land -disturbing activity will commence: 04 01 2022
Month Day
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 22.4 AC
6. Total site acreage: 26.8 AC
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner #1 Name: Stanley Martin Homes, LLC
Address: 13000 South Tryon Street, F-205
Charlotte, NC 28278
Telephone:
704-423-8988
Fax:
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone:
Email Address:
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 35967 page 280-285
Book Page
Book Page
Book Page
Year
Foml Revised 12-2016
(continue on back or separate pages as necessary)

Continue - Financial Responsibility/Ownership Form
PART B
Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Stanley Martin Homes, LLC
Address: 13000 South Tryon Street, F-205
Charlotte, NC 28278
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
Email Address:
Fax:
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 financially responsible company or entity, if not
an individual.)
Ron Willing Manager
Prin/te e/� ._ Title
Z_/� /7—Z—
Signature Date
I, �INW. U;r-nrS , a Notary Public of the
County of �MQC�LI L✓�IN�� , State of 1J01-1^^ CaN 11 , hereby
certify that ILDi ( personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this day of >r��w�r� , 20 Z Z
Notary Signature:
My Commission
ti-I2-ZoZI-
Mecklenburg County Land Use and Environmental Servi ALEY WINTERS
2145 Suttle Ave. NOTARY PUBLIC
Charlotte, NC 28208-5237 Mecklenburg County
Phone [phone] North Carolina
My Commission Exptf�_-s April 12, 2022