NCC221736_FRO Submitted_20220505

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Mecklenburg County Soil Erosion and
1 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: North Commerce Center
2. Address of land -disturbing activity: 10855 Bailey Road
3. Approximate date land -disturbing activity will commence: MarCh
1
Month Day
4. Purpose of development (Residential, Commercial, Industrial, etc.): Industrial
5. Approximate acreage of land to be disturbed or uncovered. 16.0 acres
6. Total site acreage: 17.894
2022
Year
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: NCC Bailey Road, LLC Attn: Chris Urquhart
Address: 3889 Maple Avenue, Suite 200
Dallas, TX 75219
Telephone: [phone] Fax:
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone:
Email Address:
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary):
Book 36769 page 905 Book Page
Book Page _ - Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: NCC Bailey Road, LLC Attn: Chris Urquhart
Address: 3889 Maple Avenue, Suite 200
Dallas TX 75219
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: CT Corporation c/o Crow Holding, Attn: Chris Ur uhart
Address: 160 Mine Lake Ct, Suite 200
Raleigh, NC 27615-6417
Telephone: [phone] _ Fax:
Email Address: _ [e-mail]
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.)
Christopher J Urquhart
Printed Name
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Signature
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VP Construction /
Development, Carolinas
Title
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Date
a Notary Public of the
County of State of , hereby
certify that r h(R + S_1­6PH� U K v H /( 4 T personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this `0 day of J) 4-C_
Notary Signature:
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My Commission expires: O 13 j 42 a Z G : ''
M. Co0U=
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Mecklenburg County Land Use and Environmental Services Agenc •.gyp 81-\G ,
2145 Suttle Ave. �� �j) •• i3_2p2;°�
Charlotte, NC 28208-5237 �� Ye '•••••"
Phone [phone] "/I, UPl!'a! 00 ���