NCC223889_FRO Submitted_20221129

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
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 parry 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: The Retreat at Cameron Commons
2. Address of land —disturbing activity: 2640 Harris Houston Rd, Charlotte, NC 28262
3. Approximate date land -disturbing activity will commence: August 1, 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential Development
5. Approximate acreage of land to be disturbed or uncovered: 50.5 Acres
6. List total site acreage: 108.E Acres
7. Landowners of Record (Use blank page to list additional owners):
Name: Charlotte Motor Speedway, LLC
Address: 5555 Concord Parkway South
Concord, NC 28027
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
Name:
Address:
Telephone: Fax:
(Area Code)
Email Address:
Signature:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 32811 Page 274
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:
Person or Firm: Lennar Carolinas, LLC
Address: 6701 Carmel Road, Suite 425
Charlotte, NC 28226
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: Mark. Henninger(c)-lennar.com
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(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 responsible company or entity, if not an individual.)
Mark Henninger
Printed Name
Signature
Division President
Title
Date
I, a Notary Public of the County
Of State of , hereby
certify that
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this
Notary Signature:
My Commission expires:
personally
day of 120.
12
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.charmeck.org
Page 2

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
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.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: The Retreat at Cameron Commons
2. Address of land —disturbing activity: 2640 Harris Houston Rd, Charlotte, NC 28262
3. Approximate date land -disturbing activity will commence: August 1,
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential Deve
5. Approximate acreage of land to be disturbed or uncovered: 50.5 Acres
6. List total site acreage: 108.6 Acres
7. Landowners of Record (Use blank page to list additional owners):
Name: Charlotte Motor Speedway, LLC
Address: 5555 Concord Parkway South
Concord, NC 28027
Telephone:
(Area Code)
Email Address:
Signature:
Name:
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
Fax:
(Area Code)
(Area Code)
ment
2022
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 32811 Page 274 Book Page
Book Page Book Page
Year
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Lennar Carolinas, LLC
Address: 6701 Carmel Road Suite 425
Charlotte NC 28226
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: Mark [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
(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 responsible company or entity, if not an individual.)
Mark Henninger
Printed Name
Signature
Division President
Title
Date
I 1]q. a Notary Public of'the County
Of Q f­� 1 i�j State of AJp K CH- C /4 P-0 L i M 192 , hereby
certify that AA i4-►—L P-1 W personally
appeared before me thi
Witness my hand and o
Notary Signature:
My Commission expires.
and under oath acknowledge that this form was executed by him/her.
l yyl, this day of -U � ( 20
N
PATRICIA =PSON ;
Notary Public, North Carolina
Union County
My Commission Expires �
December 07, 2025
CHARLOTTE..
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://landperniits.charmeck.org
Page 2