NCC220345_FRO Submitted_20220119

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:
PARCEL 11303105A AND 11333108
2. Address of land —disturbing activity: 7901 MARSHALL ACRES DRIVE— CHARLOTTE, NC
3. Approximate date land -disturbing activity will commence: AUGU5T15, 2021
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): INDUSTRIAL
5. Approximate acreage of land to be disturbed or uncovered: 55.00ACRES
6. List total site acreage: 92.46ACRE5
7. Landowners of Record (Use blank page to list additional owners):
Name: OLD DOWD ROAD INDUSTRIAL PROPERTIES, LLC
Address: 100 DUNBAR STREET, SUITE 400 - SPARTANBURG, SC29306
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature:
Name:
Address:
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 36074 page 684 Book Page
Book Page Book Page
Year
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Continue - Financial Responsibility/Ownership Form
PART B
1. Persons) or firms) financially responsible for this land -disturbing activity:
Person or Firm: OLD DOWD ROAD INDUSTRIAL PROPERTIES, LLC
Address: 100 DUNBAR STREET, SUITE 400 -- SPARTANBURG, SC 29306
Telephone:864•585,2000 Fax: _
(Area Code) (Area Code)
Email Address: [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: CT CORPORATION SYSTEM
Address: 160 MINE LAKE CT., SUITE 200 -- RALEIGH, NC 27615
Telephone: [phone]
(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 for the
financially responsible company or entity, if not an individual.)
Printed Name Title
00,
Signature Date
a Notary Public of the County
of 5�State of F hereby
certify that
personally
appeared before me this day and under oath acknowledge that this form was executed by him. -her.
4 0-
Witness my hand and ' seal, this ` a 20
Notary Signat e_ _
My
i
�r
CILUViom-
ENGINEERLNG A PROPERTY
MANAGEMENT
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�s1? �tY Prje
MY
COMMISSION
EXPIRES
•., 04/05122:. P
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: 704?336-6586
http:t/landpermits.charmeck.org
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