NCC223605_FRO Submitted_20221020

- Mecklenburg County Soil Erosion and
1 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.
PART A
Please Type or Print
1. Project where land -disturbing activity is to be undertaken: Rice Road Subdivision
2. Address of land -disturbing activity: 2401 Rice Road, Matthews NC
3. Approximate date land -disturbing activity will commence: 08 01 2020
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 10.80
6. Total site acreage: 13.596
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: Kinger Homes LLC
Address: 215 N. Pine Street
Charlotte NC 28202
Telephone: [phone] Fax:
Emai►•Address: [e-mail]
Owner #2 Name:
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 33437 page 756 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART 13
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Kinger Homes LLC
Address: 215 N. Pine Street
Charlotte NC 28202
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.)
Dhanesh Kumar
inted Name.
Managing Director
Title
Signature Date
©I>A � , a Notary Public of the
County of C d1 u tY'hl State of C�;iG, , hereby
certify that 'bhG-1'_'-e Sk personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand andnotarial seal, this 1p day of (1A_2n 1 , 20 a0
Notary Signature:
My Commission expires: LI Is I ` U
• M
• Y f 5; es �On
Mecklenburg County Land Use and Environmental Services Agency C� ..0 2021
2145 Suttle Ave. �G�a''•���lC •; v4
Charlotte, NC 28208-5237 ���':e�1,
Phone [phone] %%