NCC222191_FRO Submitted_20220614

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
PART A
1. Project name:
Mint f Morehead
Please Type or Print
2. Address of land -disturbing activity:1001 S Mint Street, Charlotte, NC 28203
3. Approximate date land -disturbing activity will commence: June 7
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): commerical
5. Total acreage of land to be disturbed or uncovered:1.85 Ac
6. List total site acreage: 1.418 Ac
2022_
Year
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name:Charlotte NC Properties KP6, L.P.
Address:1301 S. Capital of Texas HWY, Bldg. B, Suite 201, Austin, TX 78746
Telephone: Fax:
(Area Code)
Email Address:
Name:
Address:
Telephone:
(Area Code)
Email Address:
(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 37220 Page 624
Book 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 (Note: If the financially responsible
person(s) or firm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: Charlotte NC Properties KP6, L.P.
Address:1301 S. Capital of Texas HWY, Bldg. B, Suite 201, Austin, TX 78746
Telephone [phone]
(Area Code)
Email Address: [e-mail]
Fax:
(Area Code)
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Percnn nr Firm_ Charlotte NC Properties KP6, L.P. c/o Aspen Heights Partners
Address: 8008 Corporate Center Drive, Suite #201, Charlotte, NC 28226
Telephone: [phone] Fax:
(Area Code)
Email Address: [e-mail]
(Area Code)
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.) Authorized Signatory of Aspen M&M Manager, LLC, Manager of Charlotte NC
Properties JV KP6, LLC, Manager of Charlotte NC Properties GP KP6, LLC,
Russ Murphy General Partner of Charlotte NC Properties KP6, L.P.
Printed Name
ignatare
I,
Of
certify that
W l lur
Title
(a17l2-
Date
a Notary Public of the County
State hereby
appeared before me this day and under oath acgowledge that this form was executed by him/her.
Witness my hand and notarial seal, this A cla}l ofi2Q- 120
Notary Signature: 1 L-) CLA— U
My Commission expires: 3 1 d Z (G
sonally
••'';'A''�. LORI KOREN HOWARD
Notary Public, State of Texas
Comm. Expires 03-16-2026
"!..,r°;,ti`' Notary ID 133649738
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
hit ://charlotteiic.�,ov/dev.elo mentcenter
Rev, 09/2021 Page 2