NCC223031_FRO Submitted_20220829

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
Vineyards at Lake Wylie -Track 3 Lot 120,122-127
2. Address of land -disturbing activity:
6202 Jepson Ct., Charlotte, NC 28214
3. Approximate date land -disturbing activity will commence: August
Month
4. Purpose of Development (Residential, Commercial, Industrial, etc.
5. Total acreage of land to be disturbed or uncovered:
6. List total site acreage: 96.99
1.94
1 2022
Residential 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: Evans Coghill Homes II, LLC Attn: Alan C. Banks
Address: 4108 Park Road Suite 413, Charlotte, NC. 28209
Telephone:
704-334-6789
Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Name:
Address:
Telephone:
(Area Code)
Email Address:
ax:
(Area Code)
S. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 68 Page 896
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: Ifthefinanciallyresponsible
person(s) orfirm(s) has air ow -of .slate address, a North Carolina agent mrsl he designated in item 2 below):
Person or Firm: Evans Coohill Hordes 11. LLC Attn: Alan C. Banks
Address: 4108 Park Road Suite 413, Charlotte, NC, 28209
Telephone: - Fax:
(Area Code)
Email Address: abanks(a)evanscoahlll.Com
(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:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(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.)
Alan C. Banks
Printed Name
Signature
Managing Member
Title
-� � \ -�, t-L-z
Date
a Notary Public of the County
of e�•- n�-b►n ; , Stale o �cN^ � L� hereby
certij� that personally
appeared before me this day and under oath acknowledge that this form was executed by himlher.
Witness my hand and notarial seal, this 3day of 20�
Notary Signature: V .
My Commission expires:
0
Jami M. Grissom
NOTARY PUBLIC
Gagm County, North Carolina
Cnmmisslan Expires May 1, 2027
charlottenc.go►r
Storm Water Services -Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone. [phone]
h ttn' llc h ar to ttenco�lde�e l opm en teen ter
Rev. 0912021 page 2