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HomeMy WebLinkAboutNCC221954_FRO Submitted_20220524City 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 fling this form with the City of Charlotte Engineering and Property Management Department, Land Development Services Division or Meckienburg 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: "Stax Gym Site"- Kairof LoSo Station 2. Address of land --disturbing activity; Generally located at the addresses of 3722 S Tryon Street & 3600 S Tryon 3. Approximate date land -disturbing activity will commence: . Month 05 Day 23 Year 2022 4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential S. Approximate acreage of land to be disturbed or uncovered: 17.5 6. List total site acreage: 17.35 7. Landowners of Record (Use blank page to list additional owners): Name: Kairoi Residential 711 Navarro Street, Suite 400, San Antonio, TX 78205 Telephone: (210) 817-0024 Fax: (Area Code) Email Address: tsibley@kafroi.com Signature: Name: Address: Telephone: (Area Code) Email Address: Signature: Fax: (Area Code) (Area Code) 8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or instruments) Book 35339 Page 679 Book 35339 Page Book Page Book Page Page t Continue - Financial Responsibility/Ownership Form PART B 1. Person(s) or firm(s) financially responsible for this land -disturbing activity: Person or Firm: Hinton Construction Company, LLC. Address: 110 Dalton 5t _ Shreveport, LA 71006 Telephone:316-688-1288 Fax: (Area Code) (Area Code) Email Address: lar!y.meallister@Kintonec.com 2. North Carolina agent. for the oerson or firm who is financially responsible: Person or Fi Telephone: Fax: (Area Code) (Area Code) Email Address: 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.) Larry McAllister Senior Project Manager PxintedName _1�11_1111 Title Date ` c r a Notary Public of the County Of State of�'AQLI;�Q C-IN hereby certify that personally appeared before me this day and under oath acknowledge that this form was executed by him/her. Witness my hand and notarjtisgal, this day of )X�420 �.�. Notary Signature: r My Commission expires:F== Notary Public Cabarrus Co., North Carolina My Commission Expires Aug,10, 2023 CHARLOITL .GDfEMG i PROPERLY m1 "BArw Land Development Division 600 East Fourth Street, Charlotte, North Carolina 28202-2844 Telephone:704/336-6692 Fax:704/136-6586 httpJ/Iandpertnits.charmeck.org Pagc 2