NCC221081_FRO Submitted_20220317

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: Multifamily apartment complex located off of
Alexandriana Rd. (PID 02508104)
2. Address of land —disturbing activity: 11010 Alexandriana Road, Huntersville, North Carolina 28078
3. Approximate date land -disturbing activity will commence:
Month
4. Purpose of Development (Residential, Commercial, Industrial, etc.):
Day
Residential
5. Approximate acreage of land to be disturbed or uncovered: 19.60 ac
6. List total site acreage: 19.29 ac
7. Landowners of Record (Use blank page to list additional owners):
Name:
PPW Alexandriana -,LLC.
Address: 1341 E Morehead St. STE 201 Charlotte, NC 28204
Telephone: '70+` 4- 113lo$ Qak. kOl Fax:
(Area Code)
(Area Code)
Email Address: '�w� ���arns w•'�tew c .�a�. eow,
(;y •. {,V �'4�wnr w o a,p: w � Tr►c, i .�}S Mo►no.,�w-
Signature: ( �, uJ•�••= Prss d e*^�
Name: Vow �l �oat�d�c;o.,no�� L.LC-
Address: 1'3`il E. "0(,L._tad► S4, � S� �. COI , Chaclo'k�� NC- a*O'aO'#
Telephone: ?oy- 344— 1 %fo$ !it-• 10k Fax:
(Area Code) (Area Code)
Email Address: 'i' w �� a`"` S W `��ti�o.a Cap • '�-41 • Ce r,.,
Signature:
uiw=
2022
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 34857
Page 412
Page
Book Page
Book Page
Year
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: Evolve Companies
Address: 2012 Eastwood Rd. Wilminaton. NC 28403
Telephone: 919,455j051 Fax:
(Area Code) (Area Code)
Email Address:
Z. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
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
l�
financially res onsible company or entity, if not an individual.)
14iG4aeV r`14 560Y <T-E/ r akfel _(rr
Printed Name Title S
44/
Signature D
a Nvlary Public of the County
of e co e�Vell Co H St to of y v 2 [3�!tGLQ' hereby
certify that C t'Q' ��• personally
appeared before me This day and under oath mk►tuwle c> that tinis,iornn was executed b_v him.'her.
Witness my hand and nolaria seal. Ihi's day of . 20�
]Votary Signature.• dr
MyC:ommission expires:
•
C ILMUfffM.,
MAK"EYENT
Land Development Division
600 East Fourth Street, Charlotte. North Carolina 29202-2844
Telephone:70V336-6692 Fax:704!336-6586
http M andperm i ts.chaffneek. org
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