NCC220291_FRO Submitted_20220126

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: 105-381-02
2. Address of land —disturbing activity: 105-381-02
3. Approximate date land -disturbing activity will commence: July 1st 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 28.60 ac.
6. List total site acreage: 41.52 ac.
7. Landowners of Record (Use blank page to list additional owners):
Name: Hampton Woods Residential, LLC
Address: 1011 East Morehead Street, Suite 150
Charlotte, NC 28204
,
Telephone• 70'
Email Ad res
Signature:
Name:
Address:
Telephone:
Email Address:
Signature:
2-2500
(Area Code)
Fax:
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 35598 Page 260-265
Page
Book Page
Book Page
Page ]

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Hampton Woods Residential, LLC
Address: 1011 East Morehead Street, Suite 150
Charlotte, NC 28204
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address:
2. North Carolina agent, for the person or firm who is financially responsible:
Person ar Firm: Christopher J. Boone
Address: 2907 Providence Road
Charlotte, NC 28211
Telephone: [phone]
(Area Code)
Email Address: [e-mail]
Suite 250
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.)
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Printed Name'
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Witness my hand and notarial s_ea�l, this & day of Arr-41L 20 2-1
Notary Signature: ��� ���
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My Commission expires: J"W Za
�. ROBERT L. FROST
Notary Public, North Carolina
Mecklenburg County
My Commission Expires
July20, 2021
CHARLOTTE_
ENGINEERING & PROPEi{rY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax:[phone]
http://landperi-nits.chari-neck.org
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