NCC231318_FRO Submitted_20230504

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
Please Type or Print
PART A
1. Project name: 536 WEST TREMONT
2. Address of land—disturbing activity: 536 WEST TREMONT, CHARLOTTE, NC 28203
3. Approximate date land-disturbing activity will commence: January 1st 2023
Month Day Year
4. Purpose of Development(Residential, Commercial, Industrial, etc.):MULTI-FAMILY WITH COMMERICAL
5. Total acreage of land to be disturbed or uncovered: 1.3 AC
6. List total site acreage: 3.455 AC
7. 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: 536 W TREMONT OWNER LP
Address: 5605 GLENRIDGE DR STE 775, ATLANTA, GA 30342
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Name:704 WEST TREMONT OWNER LLC
Address:4445 Willard Ave, Suite 900, Chevy Chase, MD 20815
Telephone:_ _ Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed(Use blank page to list additional deeds or
instruments) Book 34281 Page 664 Book Page
Book Page Book Page
Page 1

Additional Property Owners
Name: 2213/2218 Toomey Avenue Owner, LLC
Address: 4445 Willard Ave, Suite 900, Chevy Chase, MD 20815
Telephone: Fax:
Email Address:

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: 536 W Tremont Owner LP
Address: 5605 Glenridoe Dr. NE Ste 775
Telephone: [phone] Fax:
(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: CT Corporation System
Address: 160 Mine Lake Ct. Suite 200, Raleigh, NC 27615
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
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.)
Michael Blair Vice President
Printed Name Title
Signature Date
I , a Notary Public of the County
oft, vt ,State of__ � hereby
certify that 1171l f- k-e-( !✓ personally
appeared before me this day and under oath acknowledge that this form was executed by hint/her.
Witness my hand and /trial seal, this l day of 2e 20 �7
Notary Signature: C G �_ ----
My Comm s -Z7-2-
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Telephone:[phone] .
http://charlottenc.gov/developmentcenter j
Rev.09/2021 Page 2