NCC223573_FRO Submitted_20221031

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership jForm
No person shall initiate any land -disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section 6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this
form with the City of Charlotte Engineering and Property Management Department, Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility 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.
PART A
Please Type or Print
1. Project where land -disturbing activity is to be undertaken: Chase Bank - Riverbend Village
2. Address of land —disturbing activity: 3816 Corning Place Charlotte, NC 28216
3. Approximate date land -disturbing activity will commence: September 30, 2022
Month i Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Commercial
5. Approximate acreage of land to be disturbed or uncovered: 1.44 acs.
6. List total site acreage: 1.16 ac.
7. Landowners of Record (Use blank page to list additional owners):
Name: Riverbend Investment Partners II, LLC
Address: 1401 Sunset Drive, Suite B, Greensboro, NC 27408
6-707-5717
Telephone. 33Fax: n/a
(Area Code) (Area Code) 1
Email Address: [e-mail]
Signature: _►{ 1_ -�':. r:
Name: N/A
Address: N/A
Telephone:
N/A
(Area Code)
Email Address: N/A
Signature: N/A
Fax: N/A
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 69
Book
Page 219
Page
Book Page
Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
I. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: JPMORGAN CHASE BANK NA
Address: 1111 POLARIS PARKWAY COLUMBUS OH 43240
Telephone: [phone]
(Area Code)
Email Address: [e-mail]
ax: N/A
(Area Code)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: BDG ARCHITECTS- CALOB HOWARD
Address: 550 SOUTH CALDWELL, SUITE 1800 CHARLOTTE, NC 28202
Telephone: [phone]
(Area Code)
Email Address. [e-mail]
(Area Code)
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 responsibl company or entity, if not an individual.)
r ,
tin
� -'C� �r
Printed Name
Signature
�
Of �1
Title
�/ 2-
Date
a Notary Public of the County
hereby
certify that _- W%"rlyo �,[ ad''e personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial mil, this 23 day of Junk— 20 7i 2-
Notary Signature:
State of 2 1( t aea_
My Commission expires: / 2fi7/J3
ANELBA BAEZ
V MY COMMISSION # GG 357673
E•a r,� EXPIRES: Odober 31, 2023
''Boi o�q`•' Bonded Thru Notary Public Undervrtiters
(A RMTTE_
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax:[phone]
http://Iandpermits.chartneck.org
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