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HomeMy WebLinkAboutNCC221576_FRO Submitted_20220425Mecklenburg County Soil Erosion and (a. Sedimentation Control Ordinance Financial Responsibility/Ownership Form No person shall initiate any land -disturbing activity covered by Section 6 of the Mecklenburg County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to completing and filing this form with Mecklenburg County Land Use and Environmental Services. The financially responsible party will be on record as the party to accept any Notices of Violation or related documents for any non-compliance with the above Ordinances. 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: Brevard Mixed Use (Joinery Phase 2) 2. Address of land -disturbing activity: 1816 N Brevard St Charlotte. NC 28206 3 Approximate date land -disturbing activity will commence: March 15 2022 Month Day Year 4. Purpose of development (Residential, Commercial, Industrial, etC.): Residential/Mixed Use/Multifa 5. Approximate acreage of land to be disturbed or uncovered: 3.45 6. Total site acreage: 3.45 7. Landowners of record (use blank pages to list additional owners as necessary): Owner#I Name: Joinery Two Owner LLC Address: 436 E 36th St Charlotte NC 28206 Telephone: 980-220-0412 Email Address: notices@spacecraft. city Owner #2 Name: Address: Fax: Telephone: Fax: Email Address: S. Indicate Book and Page where the deed or instrument is filed (use blank pages to list additional deeds or instruments as necessary): Book Page Book Page Book Page Hook Page (continue on back or separate pages as necessary) Donn Revised 12 2016 Continue - Financial Responsibility/Ownership Form PART B Person(s) or firm(s) financially responsible for this land -disturbing activity: Person or Firm: Joinery Two Owner LLC Address: 436 E 36th Street Charlotte NC 28206 Telephone: 980-220-0412 Email Address: notices@spacecraft.city Fax: 2. North Carolina agent for the person or firm who is financially responsible: Person or Firm: National Registered Agents, Inc. Address: 160 Mine Lake Ct., Suite 200 Raleigh, NC 27615 Telephone: 980-220-0412 Fax: Email Address: notices@spacecraft. city 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.) Harrison Tucker /0t Printed Name ` Title Sig re Date p Pft she , a Notary Public of the County of &h , State of Cr, 1, 4eb-,a , hereby certify that - �'✓rf5on Tustc cr personally appeared before me this day and under oath acknowledged that this form was executed by (Rher. Witness my hand and notarial seal, this day of AA 4 rrh , 20 12 Notary Signature: My Commission expires: �`'�' 3 O '2-2 7-3 o��• P HO SHE cow. # 2283742 8 NOI M PU9-IC CALIFORNIA � Mecklenburg County Land Use and Environmental Services Agency Oo,_Wly OF SAN FRQ0S0 2145 3uttle Ave. My COPY EAP MAP 30, 2W3 Charlotte, NC 28208-5237 Phone (980) 314-3234