NCC216179_FRO Submitted_20211201

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any [arid-disturb-ng activity cornered by Chapter 17. Article 2 of the Charlotte City Code or
Suction 6 of the Mecklenburg C'ounty;:imentation and Erosion Control [_]rdinance prior to completing and fling this
form with the City of Charlotte Faigineering and Pmperty Management Department. Land Development Scniccs Division
or 44eciclenburg County Land Developrocnt Services. The financial responsibility party ►gill 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 Ordirm-wc_ if the flum cially responsible party is out of State, a North Carolina agent must be assigned.
Muse Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Wood mcrehead Apanmnls
?_ Address of land -disturbing actirity:_20115 W Morehead St. Charlotte_ NC 282Q�
3. Approximate date land-diswtbing activity %%iIl commence: 03 01 2021
!Month Day Year
4. Purpose of Development (R.esiden ial, Commercial, Industrial, etc.): Comrnert;W - Muttifarrui Rpanments: _
5. Approximate acreage of land to be disturbed or uncovered: 3 35 AC
6. List total site acreage: 3.35 AC
7. Landowners of Record (Use blank page to list additional owners):
8
Name: GMHP LLC
Address: 201E W. MOREHEAD ST.
CHARLOTTE, NC 28208
Tcl .ph,,nc= 704-372-3446
(Area Cody)
Email Address: 1999DIift4boa.cam
Signature:
Name: TOLL LLC
Address: 2016 W. MOREHEAD ST
CHARLOTTE, NC 28708
Telephone: [phone]
Email Acid
Signature:
Indicate Book and Page where deed or instrwnent is filed (Use blank page to list additional deeds or
instrttment) Book 33555 Pace t 11 Bcyc�k_,'s3¢g Page 165
Fax:
i Area Cade]
Fax:
4 area Cndel (Am Code)
Book 34075 Pagr 840
Book Page
Pare 1

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 Dosion 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 Ser►•ices. The financial responsibility party will he on record as the party to
accept any Notices of Violation or related documents for any non-compliance of the City of Charlotte Sail Erosion and
Sedimentation Ordinance. if the financially res"sri-ble party is out of State, a North Carolina agent must be assigned.
7, Landowners of Record ( Use blank page to list additional awners):
Name: ___2�22 W M R
Address: 2016 W. MOFtLHEAD ST
Telephone: [phone]
(Area Code r
Email Addrr-ss: 49DOrn 208,a1 corm
Signature: -
Namc: TWRC LLC
Address: 2016 W. MOREHEAD ST-
CHARLOTTE, NC 28208
Telephone: [phone]
(Area Code)
Email [e-mail]
Signature: A
Fax:
Fax:
(Area Cade)
(Arta Code)
8. Indicate Book and Psgc where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Bank Wa Page —64s
Book 232g6 Page 435
Bank 2 --ooA Page --435.
Book Page
PWr

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: WP East Acquistions LLC
Address: 521 a Morehead Street Charlotte NC
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: iensie.teague@woodpartners,corn
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telepbonte: Fax:
(Area Code) (Area Code)
Email Address:
3. The above information is true and correct to the best of my laiowledge 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.)
Printeta y
Of ►f lCtIs I
certify that 02 t 1
appeared before me this day and under oath
Witness my hand and
Notary S1 is
My C mission exytr
this , dia--
VIA�-
Title
itit 7%,I.®
Date
a Notary Public of the County
State of —I V Or 44� UA V Ul f n fAl hereby'
that this fors exe uted by him/her.
day of t/ l/ 20 YXI
TA
Vf
%,tiQVRGl�
MMEERUM a PHEW
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2944
Telephone; 7041336-6692 Fax: [phone]
bup:I/landpermits.charmeck.org
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