HomeMy WebLinkAboutNCC233187_FRO Submitted_20231025 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.
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PART A
1. Project where land-disturbing activity is to be undertaken: Centene East Coast Headquarters
2. Address of land-disturbing activity: 2405 Governor Hunt Road, Charlotte, NC 28262
3. Approximate date land-disturbing activity will commence: January 4 2021
Month Day Year
4. Purpose of Development(Residential,Commercial,Industrial,etc.): office commercial
5. Approximate acreage of land to be disturbed or uncovered: 33.01
6. List total site acreage: 80.7
7. Landowners of Record(Use blank page to list additional owners):
Name: Centene Management Co., LLC
Address: 7700 Forsyth Blvd., St. Louis, MO 63105
Telephone: (314) 721-8427 Fax: (314)721-8533
(Area Code) (Area Code)
Email Address:
Signature: f
Name: c,Q PG 0e.�`-
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
8. Indicate Book and Page where deed or instrument is filed(Use blank page to list additional deeds or
instruments) Book 34792 Page 819-834 Book _ Page
Book Page 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:
Person or Firm: Centene Management Co., LLC
Address: 7700 Forsyth Blvd.. St. Louis, MO 63105
Telephone: (314) 721-8427 Fax: (314) 721-8533
(Area Code) (Area Code)
Email Address: tim@rafcoprop.com
2. North Carolina agent,for the person or firm who is financially responsible:
Person or Firm: �Ari&-24-.1 12.?2 �• G G c .2&to irrt c N/ 51-S7 w1
Address: I let) !til a We— L.641G- Gnv IL1 S V tZ r.244:14 IZAtza tGH, r4C z.7Gt c L4 r-
Telephone: Coll 9f) 4.4" - g 4.0 Fax:
(Area ode) (Area Code)
Email Address:
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.)
(f , I - '��.-I,C� Gg,(41442.5 12.gi9 ri.ascwTit j toe.
Printed Name Title
ktna Date
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1 tr2r, n (11-171,i l� , a Notary Public of the County
of SA . U)Lt t � ,, , State of VU t S S CLA.r i , hereby
cert fy !
that_ Ob`ltl 5 4Lfo,QA personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and n lanai seal, this day of cerrvAb2+� , 20 <DO
Notary Signature: i (R 2L - - -
My Commissio,a expires: Q3-aS -aaDac-
HEATHER LYNN RIZZELLO
NOTARY PUBUC-NOTARY SEAL
STATE OF MISSOURI
• COMMISSIONED FOR ST.LOUIS COUNTY
(C1X MY COMMISSIION EXPIRES MAK 25,2022
ID.18906933
ClEARLOTTIL
ENGa18WNG a PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone:704/336-6692 Fax:704/336-6586
http://landpermits.charrneck.org
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