NCC216677_FRO Submitted_20211201

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered 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 relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A luxury auto body 2
1. Project name: ---
2. Address of land —disturbing activity: 4750 reagan dr charlotte nc 28206
3. Approximate date land -disturbing activity will commence: 10/30/2021
Month Day Y` `" -
4. Purpose of Development (Residential, Commercial, Industrial, etc.): commercial
5. Total acreage of land to be disturbed or uncovered: 2.9
6. List total site acreage: 5.8
7. Landowners of Record (attach accompanied page to list additional owners) If the lan record not
s
�t
1�(". tnc.rTciall "responsible as listed m g �'a'�p `. titter of consent st��ned
by the landowner of record or their authorized agent is required:
Name: kt trading llc__-
9222 monroe rd charlotte nc 28270
Address:—
Telephone: —
Email Address:
Name:
—
A AA-
7049607474 Fax:
(Area Code)
[e-mail]
(Area Code)
huey tran
9222 monroe rd charlotte nc 28270
Telephone: [phone] Fax: --
(Area Code) (Area Code)
Email Address: kttrading9999yahoo.eom
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds e
instruments) Book 31169 Page
450
Book Page
Book Page Book Page

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity(Note: If the financially responsible
person(s) or firm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: kt trading IIc
Address: 9222 monroe road charlotte nc 28270
Telephone: 704Af67474 Fax:
(Area Code) (Area Code)
Email Address:-<[e-mail]
2, if the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
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 I,or the
financially responsible company or entity, if not an individual.)
Printed Name itle
Signature
1;
Of_
State of
1 3 2I
Date
a Notary Public of the Co�inty
tern& that personally
alrpeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this day of -
Notary Signature:
My Commission expires:
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
hqp://charlottencgov/developmentcenter
20
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1%._c
Rev. 09/2021