NCC221160_FRO Submitted_20220329

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:
north of 1-485 (Tax Parcel IDs 20108201, 20108202 and 2010711
Steele Creek Commerce Park - Phase IV
West side of Sandy Porter Road immediately
2. Address of land —disturbing activity: Ne; AssigRed `r""""""" "" 4833 Sandy Porter Dr
3
Approximate date land -disturbing activity will commence: November
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Industrial
Approximate acreage of land to be disturbed or uncovered:
6. List total site acreage: 24.25 Acres
19.0 Acres
7. Landowners of Record (Use blank page to list additional owners):
Name: EastGroup Properties LP
Address
2966 Commerce Park Drive, Suite 450, Orlando FL 32819
Telephone: [phone]
Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature:
Name:
Address:
Telephone: Fax:
(Area Code)
Email Address:
Signature:
(Area Code)
2021
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 30682 Page 099 Book 31678 Page 184
Book 30618 Page 095 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: EastGroup Properties LP
Address: 2966 Commerce Park Drive Suite 450 Orlando FL 32819
Telephone: 404.301,2670
(Area Code)
Email Address: [e-mail]
Fax:
(Area Code)
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 27615-6417
Telephone: 919.821,7139 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
financially responsible company or entity, if not an individual.)
Ronald Coffey Construction Manager, EastGroup Properties LP
Printed Name Title
1 IL
Of
certify that
V' IP7i
Date
, a Notary Public of the County
State of Georgia hereby
personally
appeared before me this day and under oath acknowledge that this form 1was executed by him/her.
Witness my hand and nota�vl seal this day of 20.021
Notary Signature:
My Commission expires:
NN BR44f' r
• �J
N ,o OTARyso
' ;
"I1 PUB1rIC,� o�
Land Development Division
600 Last Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://landpermits.charmeck.org
•
cfwu.oM.
INGINMUNG A PROI'IRTY
MANAGIMINT
Page 2