NCC230479_FRO Submitted_20230217

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more, acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and. sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible party will be.on record as the party to accept any Notices
of Violation or related documents for any non-compliance of the City 6f Charlotte Soil Erosion and Sedimentation
Ordinance. If the financially responsible party is out of State, a North Carolina agent must be assigned. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: Aubreywood
2. Address of land -disturbing activity: 10325 Beagle Club Road, Charlotte, NC 28214
3. Approximate date land -disturbing activity will commence:
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Single Family Homes
5. Total acreage of land to be disturbed or uncovered: 12.0 Ac
6. List total site acreage: 18.7 Ac
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: Andrew N Miller & Lisa C Miller
Address: 11650 Twining Ln, Potomac, MD 20854
Telephone:
(Area Code)
Email Address:
Name: Dependable Development Inc.
ax:
Address:10325 Beagle Club Road, Charlotte, NC 28214
Telephone:
(Area Code)
Email Address:
ax:
(Area Code)
(Area Code)
Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 20788 Page 90 Book Page
Book 37338 Page 847 Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity (Note: /fthe,tinancially responsible
person(s) or,frm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: True Homes
Address: 2627 Brekonridge Centre Drive Suite 104, Monroe, NC 28110
Telephone:
(Area Code)
Email Address: [e-mail]
(Area Code)
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
ax:
(Area Code)
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.)
Shaun Gasparini Market Partner - Land Development
Printed Name Title
Signature Date
' 1 fw u - 1` r V .. i a Notary Public of the County
u of— �&m State of R hereby
certify that personally
appeared before me this day and under oath acknowledge that this•, form was executed by him/her.
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Witness my hand and no 1, this day of , 20
Notary Signature: t ].
My Commission expires: _G
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My Comm. Exp. _
11/6/2022
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Rev-09/2021
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
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