NCC233442_FRO Submitted_20231117

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing actin its on one or more acres as cosrrcd 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 of Charlotte Soil Erosion and Sedimentation
Ordinance. if the financially responsible party is out of State,a North Carolina agent must be assigned. All rekvant
items on this form must be filled out accurately and completely
PART A Please Type or Print
I. Project name: Hager Dr Townhomes
2. Address of land—disturbing activity: 0 Hager Dr
3. Approximate date land-disturbing activity will commence: October
25 2023
Month Day Year
4. Purpose of Development(Residential,Commercial,Industrial,etc.): Residential
5. Total acreage of land to be disturbed or uncovered: 1.70
6. List total site acreage: 3.051
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: Golden Boy Properties, LLC
Address: 800 Lochridge Rd
Charlotte, NC 28209
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Name:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed(Use blank page to list additional deeds or
instruments) Book 32975 Page 844 Book Page
Book Page Book Page
Paiget

Continue - Financial RevossibilityfOwnership Form
PART In
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Email Addreasligolkurladotnottent
2, ifthe Financially Rcconaible Party is not a reside*of Notts sine Dame and sum* Maw of the
designated North Carolina agent:
Person or lints;
Address:
Telephone: Fax:
(Ares Code) (Area Colo
1':mail Address:
3. The above information is true and owed to the best of my knovrkdge and bchct and was provided hey rule
while under oath. (This form must he signed by the ftnancialb reworrsibk per ion If an truly ill or by an
officer.director, partner. anorney--in-fact.or other pinion with authority to executor instrument" Cur the
financially responsible company or entity,if ont an individual.)
Kurt Odom
Printed Name Title
Siviature Doe
I, are..J.. S C ra1.0 - s a Notary Public uf the L'Iiwuj
of M r, znb..' Store of
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rertib'than r . .f t)
penunully
appeared befiirie one this day and wider oath a heolcialge that this furs was executed b 4 htnv her7 el
Witness m►'hand and malarial sad this dui of "V . 20 11
Notary Signatnar: .
My Commission expires: M iy 2 3, 2 c t (a))7 - --
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