NCC222862_FRO Submitted_20220831

CHaU PR p
- z Mecklenburg County Soil Erosion and
It Sedimentation Control Ordinance
RT oa CA Financial Responsibility/Ownership Form
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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 fling 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: Lake Norman Powersports
2
Address of land -disturbing activity: 20210 Chartown Dr Cornelius, NC 28031
3. Approximate date land -disturbing activity will commence: July 1 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Commercial
5. Approximate acreage of land to be disturbed or uncovered: 4.35
6. Total site acreage. 4.469
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner #1 Name: AHE Holdings LLC
Address: 7607 Woods Lane, # 55 Cornelius NC 28031
Telephone: [phone] Fax:
Email Address: [e-mail]
Owner #2 Name: N/A
Address:
Telephone:
Email Address:
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 36817 page 124-126 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART B
Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: AHE Holdings LLC
Address: 7607 Woods Lane, # 55 Cornelius NC 28031
Telephone: [phone]
Fax:
Email Address: [e-mail]
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.)
Dana Martin
Printed Name
Signature
Owner
Title
1 /25/2022
Date
I, -d6L,X:, 1-355iV94, a Notary Public of the
County of I )„tJ�`f� , State of ��n,)�; hereby
certify that
personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand anti otarjl sexrjhis day of 1110q %('IVi , 207-Z-1 .
Notary Si
My Commissif n Zpires:
31
JOSHI IA ROSSO N
NOTARY PUBLIC
Qavie raj nty
North Carolina
*Commission Expires Oct. 31, 2023
Mecklenburg County Land Use and Environmental Services Agency
2145 Suttle Ave.
Charlotte, NC 28208-5237
Phone [phone]