NCC216159_FRO Submitted_20211108

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 parry 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: Longdale Drive Multifami
2. Address of land —disturbing activity: 2225 Longdale Drive, Charlotte, NC
3. Approximate date land -disturbing activity will commence: May 15 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered
6. List total site acreage: 1.02
1.61
7. Landowners of Record (Use blank page to list additional owners):
Name: Elite Realty Ventures LLC
Address: 483 Georges Road, North Brunswick, NJ 08902
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature:
Name: Satya Garimella
Address: 483 Georges Rd, north Brunwsik, NJ 08902
Telephone: Fax:
(Area Code)
Email Address:
Signature:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 34935 Page 448 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: Echelon Ventures LLC
Address: 9647 Ashlev Green Court NW
Telephone: 7Q7 — 2—(+9—Z.092__ Fax:
(Area Code) (Area Code)
Email Address: - Ie<<he1ov, Akc-@ 9wta,I - CD!M
OF
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: CC)ie(0A Ve ✓1f(A °u tL C-
Address: 9;441 AAklem QWrovi eX Oc.
Telephone: 20 7 _1 f S - 209'L.- Fax:
(Area Code) (Area Code)
Email Address: _ the on l k Cw*"
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.)
fvv� %Kr(g¢v►�,r
Printed Name p Title
Signatuze „ i Date
I,
a Notary Public of the Couniv
of v CGt, b Ct, e- r l c. �/ ,State of / l�o�14 Cry„ 0 `L vt� hereby
certify that SuJ eS � 1`I.LWlG-f �t� A`0. personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, t 's t'� day of e�r�4r _ 20Zi
Notary Signature: - -
My Commissio*expires:
Jacgi relline Dumitreseu
NOTARYPU)BU C
Mtckleaburg County
lina
Car olina
Caro
01ARI Mn-
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://landpermits.channeck.org
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