NCC221576_FRO Submitted_20220425

Mecklenburg 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: [phone]
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: [e-mail]
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: [phone] 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 [phone]