NCC241269_FRO Submitted_20240424

Mecklenburg County Soil Erosion and
60.3-12;10 Sedimentation Control Ordinance
Financial Responsibility/Ownership Form
Nu person shall initiate any land-disturbing activity covered by Section 6 of the Mecklenburg
County, Mint 11111 or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Ens ironmenul
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 abose 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:
8405 Max Meadows Drive, Charlotte, NC 28227
2. Address of land-disturbing activity:
8405 Max Meadows Drive, Charlotte, NC 28227
3. Approximate date land-disturbing activity will commence: January 15 2024
Month Day Year
4. Purpose of development (Residential,Commercial, Industrial,etc.): Res,dontial
5. Approximate acreage of land to be disturbed or uncovered: 1.50 ac.
6. Total site acreage: 2 225
7. Landowners of record(use blank pages to list additional owners as necessary):
Owner#1 Name: Ana C. Sorto
Address:
1636 Peachtree Rd.
Charlotte, NC 28216
Telephone: [phone] Fax: n/a
Email Address: [e-mail]
Owner tt2 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 37719 Page 853 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Revisal 12-2016
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Continue - Financial Responsibility/Ownership Form
PART it
I. Person(s)or firm(s) financially responsible for this land-disturbing activity:
Person or Firm: Ana C. Sorto
Address: 1636 Peachtree Rd.
Charlotte, NC 28216
Telephone: [phone] Fax: n/a
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone: Fax:
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.)
Ana C. Sorto Landowner
Printed Name Title
Jor+0 1 - IS - Z3
Signature Date
1, I aloe-s 'r'af1. ./ , a Notary Public of the
County of NIcck( bu , State of AJO{-k Q CO Ana hereby
certify that Ocroa e• SO{4-0 personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial^^ r seal, this iQ day f eCtemb-€c , 20 .. .
Notary Signature: c10.JA
My Commission expires: SC p4-Grrt()t e' ' t a o -%'
Mecklenburg County Land Use and Environmental Service Atenc)TA}(ESHALEE PRATHER
2145 Sunke Ave. NOTARY PUBLIC
Charlotte,NC 28208-5237 Mecklenburg County
Phone[phone] North Carolina
My Commission Expires Sep 09.2028
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