NCC216387_FRO Submitted_20211115

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.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Sed efield Mixed Use — Parcel B
2. Address of land —disturbing activity: 2825 South Blvd. Charlotte, NC 28209
3. Approximate date land -disturbing activity will commence: 01 02 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Commercial
5. Approximate acreage of land to be disturbed or uncovered: 3.85 ac
6. List total site acreage: 2.48 ac
7. Landowners of Record (Use blank page to list additional owners):
Name: Marsh Realty Co. c/o Jamie McLawhorn
Address: 2401 Park Rd.
Charlotte NC 28203
Telephone: [phone] Fax:
(Area Code)
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 19808 Page 734
Book 33741 Page 434
Book 2853 Page 391
Book 5396 Page 519
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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: Marsh Properties, LLC c/o Jamie McLawhorn
Address: 2401 Park Rd.
Charlotte NC 28203
Telephone: 704.602,2062 Fax:
(Area Code) (Area Code)
Email Address: 'mclawhorn marsh ro erties.com
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: Banks Engineering c/o Jav Banks
Address: 1919 South Blvd. Ste. 200
Charlotte NC 28203
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: ibanks@.civilbanks.com
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.)
Jamie McLawhorn President
Printed Name n Title
41L
of --A
certify that
appeared before me this day and under
Witness my hand and notarial s4al, this
Notary Signature:
My Commission expires:,
State of
( .?-( 39-�-o
Date
a Notary Public of the County
hereby
personally
that this form was executed by him/her.
day of LL 20 2u
6
CHARLOTTE.
EWMEINNG & PROPERTY
MA-MGEMENT
Land Development Division �
600 East Fourth Street, Charlotte, North Carolina 28202-2844 %.,,�8
Telephone: [phone] Fax: [phone]
http://landpennits.chartneek.org
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