NCC232873_FRO Submitted_20230922

Mecklenburg County Soil Erosion and
Sedimentation Control Ordinance
4' 1 : 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
1. Project where land-disturbing activity is to be undertaken: River Run Country Club Sports Facility
2. Address of land-disturbing activity: 18801 Greyton Ln. Davidson, NC 28036
3. Approximate date land-disturbing activity will commence: August 1 2023
Month Day Year
4. Purpose of development(Residential, Commercial, Industrial, etc.): Commercial
5. Approximate acreage of land to be disturbed or uncovered: 1.96 AC
6. Total site acreage: 22.39 AC
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: River Run Golf & Country Club Inc.
Address: 19125 River Falls Dr. Davidson NC 28036
Telephone: [phone] Fax:
Email Address: wmarshall©riverruncc.com
Owner#2 Name:
Address:
Telephone: Fax:
Email Address:
8. Indicate Book and Page where the deed or instrument is filed(use blank pages to list
additional deeds or instruments as necessary):
Book 32 Page 513 Book 32 Page 515
Book 32 Page 517 Book 32 Page 519
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART B
I. Person(s) or firm(s)financially responsible for this land-disturbing activity:
Person or Firm: River Run Golf and Country Club, LLC
Address: 19125 River Falls Dr., Davidson, NC 28036
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Wesley Marshall
Address: 19125 River Falls Dr., Davidson, NC 28036
Telephone: [phone] Fax:
Email Address: [e-mail]
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.)
Wes Marshall _ General Manager
Printed Name -. Title
9. 6-13-23
Signature Date
P2yYLr , a Notary Public of the
County of t, State of ,hereby
certify that Wes* r S' v t personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and n, 1.1_ial seal,this 13 day of.1_4, _ 20 23 .
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