NCC230205_FRO Submitted_20230131

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
Evoke Living at Morris Field
2. Address of land —disturbing activity: 3612 Morris Field Drive
3. Approximate date land -disturbing activity will commence: July 18 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Multi -Family Residential
Total acreage of land to be disturbed or uncovered: 7.11 acres
6. List total site acreage:6.97
acres
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: CSE Communities LLC
Address: 121 West Trade St. Suite 2550 Charlotte, NC 28202
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Name: Greenwood Development Group LLC
Address: 8410 Fairview Rd. Charlotte, NC 28226
Telephone:
Email Address:
Fax:
(Area Code) (Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 37015 Page 53 Book 25800 Page 677
Book 31346 Page 750 Book 18239 Page 677
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity (Note: If the financially responsible
person(s) or firm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm
Address: 121
CSE Communities LLC
West Trade St. Suite 2550 Charlotte, NC 28202
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
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: CSE Communities LLC
Address: 121 West Trade St. Suite 2550 Charlotte, NC 28202
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: BJamesp_csere.com
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.)
Printed Name Title
Signature
certify that atX (-
appeared before me this ,
Date
a Notary Public of the County
State o, hereby
and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this,
Notary Signature:
My Commission expires:
of Mc-rck' , 20 Qa-
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
http://charlottenc.gov/developmentcenter
Rev. 09/2021
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Continued - Financial Responsibility/Ownership Form
7 (cont). Landowner(s) of Record:
Name: Greenwood Development Group LLC
Address: 8410 Fairview, Road, Charlotte. NC 28226
Telephone: N/A
Current Mailing Address: 8410 Fairview, Road, Charlotte. NC 28226
Current Street Address: 8410 Fairview, Road, Charlotte. NC 28226
8 (cont). Deed Book No. 21650 Page No. 116
Page 3