NCC221738_FRO Submitted_20220512

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...y.. Mecklenburg County Soil Erosion and
.1 Sedimentation Control Ordinance
Financial Responsibility/Ownership Form
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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
171 t40.1
1. Project where land -disturbing activity is to be undertaken:
Davidson Woods - Phase II
2. Address of land -disturbing activity:
Tax Parcel 00709102
3. Approximate date land -disturbing activity will commence: May 27 2022
Month
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 18
6. Total site acreage: 31.8
Day Year
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner #1 Name: Artisan Knox LLC
Address: 126 South Main Street, Suite 2A
Davidson, NC 28036
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 16997 Page 708 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Forni 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: Davidson Woods Bowman LLC
Address: 13815 Cinnabar Place Huntersville, NC 28078
Telephone: [phone]
Email Address: bowman3l @gmail.com
Fax:
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
Email Address:
Fax:
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.)
Robert Bowman
Printed
Manager
Title
2'7 Z v
Date
I,a Notary Public of the
County of �sea�ra State of 6�¢t Lk NA , hereby
certify that ►CedGaT Z')U%,AAµ 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 2-% day of /PP-9% L_ 520 2 2
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Notary Signature:
My\Comm ssion expires:
3 •2.3. 2 0Z4
Mecklenburg
County Land Use and Environmental Services Agency
Notary Public _
2145 Suttle Ave.
= Gaston County =
Charlotte, NC 28208-5237
-
Phone [phone]
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