NCC222687_FRO Submitted_20220727

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 I7 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
Please Type or Print
PART A
1. Project name: Sugar Creek Apartments
2. Address of land —disturbing activity: 230 W Sugar Creek Rd Charlotte, NC 28213
3. Approximate date land -disturbing activity will commence: November 1 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Multi Family Residential
5. Total acreage of land to be disturbed or uncovered: 9.19 Acres
6, List total site acreage: 10.95 Acres
7. Landowners of Record (attach accompanied page to Iist 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: Sugar Creek Apartments LLC
Address: 1228 Euclid Ave, 4th Floor, Cleveland, 4H 44115
Telephone: [phone] Pax.
(Area Code) (Area Code)
Email Address: imochizuki(cDnrpgroup.com
Name:
Address:
Telephone:
(Area Code)
Email Address:
ax:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36600 Page 663
Boole 36600 Page 666
Book 36600 Page 660
Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
1. Person(s) or firm(s) financially responsible for this land -disturbing activity(Note: lfthe financially responsible
person(s) or frrm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: Sugar Creek Apartments LLC
Address:1228 Euclid Ave 4th Floor Cleveland OH 44115
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail] _
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: CT Corporation System
Address: 160 Mine Lake Court Suite 200 Raleigh, NC 27615
Telephone:. [phone] Fax:
(Area Code) (Area Code)
Email Address: imochizuki(@nrpciroup.com
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.)
Printed Njwr) Title V\X-f .W-Lr
Signature
I�IZ2.
Date
I, i� QrAfl! - L V a Notary Public of the County
of C N to XVI dU & State of6h i G ; hereby
certify that N O0.� MrA At CC personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seat, this day of lI 20
Notary Signature: I -
My Commission expires: V
Rev. 09/2021
sM
chanotienc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
http://charlottenc.gov/developmentcetiter
Notary Public, State Samuels
Ohio
My Commission Expires:
June 30,2026
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