NCC222157_FRO Submitted_20220616

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Mecklenburg County Soil Erosion and
` 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: Hoke Townhomes
2. Address of land -disturbing activity: 351 Jetton Street Davidson, NC 28036
3. Approximate date land -disturbing activity will commence. 07 01 2021
0
5.
Gol
Month
Purpose of development (Residential, Commercial, Industrial, etc.): Residential
Approximate acreage of land to be disturbed or uncovered: 6.40
Total site acreage. 5.61
Day Year
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner # 1 Name: 347 Jetton, LLC
Address: 2626 Glenwood Avenue, Suite 550
Raleigh, NC 27608
Telephone: [phone]
Email Address: [e-mail]
Owner #2 Name:
Address:
Telephone:
Email Address:
Fax:
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 33517 page 599 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
16AIINIItI3
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Taylor Morrison
Address: 11405 North Community House Road
Charlotte, NC 28277
Telephone: [phone]
Email Address: [e-mail]
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.)
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Printed Name 1
Signature
V "Wo
Title
Date
I, _ S%nc- a Notary Public of the
County of MLA.(~ (-e_760V- A , State of NOVtk C_CA.('() r)a hereby
certify that 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 LQ day of L , 2
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Notary Signature. 1
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My Commission expires: { V t i
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Mecklenburg County Land Use and Environmental Services Agc=w.
2145 Suttle Ave. -W 4040
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Charlotte, NC 28208-5237 °'v��� 4*
Phone [phone]
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