NCC221903_FRO Submitted_20220518

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: The Enclave at Caldwell
2. Address of land —disturbing activity:
12401 Caldwell Road, Charlotte, NC 28213
3. Approximate date land -disturbing activity will commence
4
5
G'1
Month Day
Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
Approximate acreage of land to be disturbed or uncovered: 6.76 acres
List total site acreage: 6.95 acres
7. Landowners of Record (Use blank page to list additional owners):
Name: Lloyd R Jones and Katherine M Jones
Address: 3000 Windrow Ln, Matthews, NC 28105
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature: Name: Lloyd Lloyd Ad Jones and Alice Simpson
Address: 12401 Caldwell Rd, Charlotte, NC 28213
Telephone: -10`i — `1 1 `(- ;2.) i Fax:
(Area Code) (Area Code)
Email Address: 0
Signature: Q v V AA-T.
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 34370 page 301 Book Page
Book 10032 page 406 Book Page
2022
Year
Page l

Continue - Financial Respuniihilit}- Ownership Form
PART 8
1 Pcrsorgsy or firnt[s) financially responsible for tliii iind-disturbing activity:
Person or Fimt: KmW Hordes LLC
Address: 215 N. Pine Street Unit 320b. NC 28210
Tcicphonc: Fax:
(Atra codes (Are. Coen)
Finall Address dh►on@Sh�IdrlQArhDmes_CO111 _
2. Tenth Carolina agent for the person or firm wbio is financially responsible:
Perme or Finn:
Telephone:
4M= CO&I
Ex nail Addms:
Fax.
[wra Cody)
3. The above Information is !more ued olxred to the beat of my knowledge and bclicr and was provrdod by me
while smiler oath. !This form must be signed by the fir>,amully vc%ponsibk person if an individual or by w
ofTwer. dirmtor, pawner. attorney -in -fact, or wha person with arltbOOly to execute ='runwnts for the
fmaw ally re +pombk company or en ity, if not en i"vi".)
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