NCC221711_FRO Submitted_20220503

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:
Union at Tryon, LP
2. Address of land —disturbing activity: 302 Hampton Church Road, Charlotte, NC 28262
3. Approximate date land -disturbing activity will commence: May 16, 2022
Month Da Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Multi -Family Development
5. Approximate acreage of land to be disturbed or uncovered: 7.18
6. List total site acreage: 7.531
7. Landowners of Record (Use blank page to list additional owners):
Name: Union at Tryon, LP
Address: 409 Massachusetts Avenue, Suite 300, Indianapolis, IN 46204
Telephone: [phone] Fax:
(Area Code)
Email Address:
Signature:
Name:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36772 page 376-384 Book Page
Book Page Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Union at Tryon, LP
Address: 409 Massachusetts Avenue, Suite 300, Indianapolis, IN 46204
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: joy(CD-theannexgrp.com
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: CT Corporation System
Address: 160 Mine Lake Court, Suite 200
Raleigh, NC 27615
Telephone: Fax:
(Area Code)
Email Address:
(Area Code)
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.)
Kyle Bach
Printed Name
Signature
1,
Of
certify that
CEO
Title
4--
Date
a Notary Public of the County
State of hereby
personally
appeared before me this day and under oath acknowledge that this form was xecuted by him/her.
Witness my hand and notarial seal, this q day of 20A
Notary Signature:
My Commission expires) [iCI--& f C —, czVC:9 -?
""Y""P'' " JOELLA KUDJO
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��`�PP••• �e�'%; Notary Public, State of Indiana
Hamilton County
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s+•• + Commission Number722934
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', 'NOIANP c` My Commission Expires
October 14, 2027
CHARLOTTE,
ENGINEERING& PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.charmeck.org
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