NCC222541_FRO Submitted_20220725

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:
Please Type or Print
FOREST PARK HOMES
2. Address of land —disturbing activity: 7150 FOREST POINT BOULEVARD
CHARLOTTE, NC 28217
3. Approximate date land -disturbing activity will commence: MAY 1 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.):
5. Total acreage of land to be disturbed or uncovered: 11.63 ACRES
G. List total site acreage: 16.5 ACRES
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: FOREST PARK FAMILY APARTMENTS LLC
Address: 1228 EUCLID AVENUE, 4TH FLOOR, CLEVELAND OHIO 44115
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: JMOCHIZUKI NRPGROUP.COM
Name:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36715 Page 235 Book Page
Book Page Book Page
Page I

Continue - Financial Responsibility/Ownership Form
PART S
1. Person(s) or firm(s) financially responsible for this land -disturbing activity (Note: lfthe financially responsible
person(s) or ftrm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm.: FOREST PARK FAMILY APARTMENTS LLC
Address: 1228 EUCLID AVENUE 4TH FLOOR CLEVELAND OHIO 44115
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: JMOCHIZUKI NRPGROUP.COM
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm: mKEST PARK FAMMY APARTMENTS ttCr—LANDDESIGN, INC.
Address: 223. N. GRAHAM ST. , CHARLOTTE NC 28202
Telephone: - - .0325 Fax: fmcmahanUla.nddesign.com
(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.) Forest Park Family Apartments LLC
By: NRP Forest Park Family Apartments LLC, its Class B Member
By: NRP Manager LLC, its Manager
Noam Ma ence By, Noam Maeence Secretary `
Printed Name .. I Title {
I,
IL -r6 2°ZI
Date
a Notmy Public of the County
State of 0 kk b, hereby
certify that Yri- Crt M2W t L.t �•��••�••y
appeared before me this day and under oathacknowledgeacknowledge that this form was executed by him/her.
Wtiness my hand and notarial seal, this I day of 20 2
Notary Signature: f/� V '� `r_ v `� 1-
My Commission expires: d [�
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
htt ://charlottene. ov/develo menteenter
Emma Samuels
Notary Public, State of Ohio
My Commission Expires:
June 30,2026
Page 2
Rev. 0912021