NCC220754_FRO Submitted_20220215

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 forrn 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: SorrtliRrril Statio►r (aka, 200 E. Woodlawn —
Townhomes), Lots 93 —102 131d s .1020 & 1021
2. Address of land —disturbing activity: Southline Dr. & Station Crossigg,Ave.
3. Approximate date land -disturbing activity will continence: Feb. 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Tow►thorne Construction
5. Approximate acreage of land to be disturbed or uncovered: 0.23 ae.
6. List total site acreage: 16.9 ac.
7. Landowners of Record (Use blank page to list additional owners):
Name (1) : Exeter District Developers, LLC
Address: 1905 Woodstock Road, Suite 9250
Roswell. GA 30075
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: Jeff Snierkoxeterdeveo.coin Je e► Snterka
Signature: See Authorization Letter f •om Own er
Name (2):
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36095 Page 562 Book Page
Book Page Book Page
Page I

Continue - Financial Responsibility/Ownership Form
PART B
1, Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: NVR, Inc. Nba Rvan Homes
Address: 10710 Sikes Place, Suite 250
Charlotte, NC 28277
Telephone: _ _ _ [phone] Fax: N/A
(.Area Code) (Area Code)
Email Address:. 'kit niak(a)jtvrine.com (Jared Kintak) _
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: Corporation Service Compan
Address: 2626 Glen wood Avenue, Suite 550
_ Raleiglt, NC 27608
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: N/A
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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Date
vy Public of the County
of "uY 1 {{ State of 1 V44 YV V t LtV 0 l 11r1..lit' . hereby
certify that J D A m'L &A& � S personally
appeared before me this day and under oath ack►toWedge that this form ivas executed by hina/her.
Witness my hand and
Notal y Signature:
My Commission expires: rd - (
this ^��-� day of J MAAA Ou 20 )9_0
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Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone:[phone] Fax:[phone]
littp:Hlandperinits.charmeck.org
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