NCC221575_FRO Submitted_20220504

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: Smith Farms -Prosperity Ridge Townhomes
2. Address of land —disturbing activity: Prosperity Ridge Road and Johnston Oehler Drive
3. Approximate date land -disturbing activity will commence: February 01 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 12.0 Ae.
6. List total site acreage: 12.5 AC.
7. Landowners of Record (Use blank page to list additional owners): (4501 Johnston
Name:Linda P. Smith & Stanley W. Smith Co -Trustees Under Linda P. Smith Living Trust Oehler Road)
Address: 4501 Johnston Oehler Road, Charlotte, NC 28269
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
Signature: (4840 Prosperity
Name: Linda P. Smith & Stanley W. Smith Co -Trustees Under Linda P. Smith Living Trust Church Road)
Address. 4501 Johnston Oehler Road, Charlotte, NC 28269
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 9982 Page 492
Book 9982 Page 492
Book Page
Book Page
Page 1

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: Smith Farms -Prosperity Ridge Townhomes
2. Address of land -disturbing activity: Prosperity Ridge Road and Johnston Oehler Drive
3. Approximate date land -disturbing activity will commence: Februar
Month
4. Purpose of Development (Residential, Commercial, Industrial, etc.):_
5. Approximate acreage of land to be disturbed or uncovered: 12.0 Ac.
6. List total site acreage: 12.5 Ac.
7. Landowners of Record (Use blank page to list additional owners):
Name: Robert Neal Elliott & Rose Ann S.
Address: 4421 Johnston Oehler Road, Charlotte, NC 28269
Telephone:
(Area Code)
Email Address:
Signature:
Name:
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
Fax:
y 01 2022
Day Year
Residential
(Area Code)
(Area Code)
(4421 Johnston
Oehler Road)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 02132 Page 079
Page
Book Page
Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Pulte Home Company LLC
Address: 11121 Carmel Commons Blvd. #450, Charlotte NC 28226
Telephone:_ 704-972-0752 Fax:
(Area Code)
Email Address [e-mail]
(Area Code)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or F
Address:
Telephone:
(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.)
Jeremy Huntsman
Printed Name
Signature
1
I,
o
certify that 7:S rl—�. M\
appeared before me this day and u,
Witness my hand and notarial seal,
Notary Signature:
My Commission ax . s:
Director of Land Development
Title
gqa
Date
. a Notary Public of the County
State of hereby
personally
oath acknowledge that this form was executed by him/her.
day of 20 2-4
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cHnw.oTrE.
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 Last Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.chamieck.org
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