NCC232414_FRO Submitted_20230811

Town of Huntersville
1knIèiite Soil Erosion & Sedimentation Control Ordinance
NORTH CAROLINA Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By filing this form, the parties are not relieved from any other permits that may be
required for the Project. 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: Vermilion Village
2. Address of land-disturbing activity: 12145 Huntersville-Concord Road/Huntersville,NC
3. Approximate date land-disturbing activity will commence: 07 01 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential&Commercial
5. Approximate acreage of land to be disturbed or uncovered: 28.1
6. Total site acreage: 29.58
7. Landowners of record (use blank pages to list additional owners as necessary) :
Owner#1 Name: Vermillion Anchor Mill Village,LLC
Address: 13815 Cinnabar Place/Huntersville,NC 28708
Telephone: [phone] Fax:
Email Address: [e-mail]
Owner#2 Name: Vermillion Village,LLC
Address: 2400 South Boulevard,Suite 300/ Charlotte,NC/28203
Telephone: Fax:
Email Address:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book 31943 Page 497 Book 32414 Page 343
Book Page Book Page
11/19

Financial Responsibility/Ownership Form - Continued
PART B
1. Person(s) or firm(s) financially responsible for this land-disturbing activity:
Persons or Firm: Vermillion Anchor Mill Village, LT,C
Address: 13815 Cinnabar Place/Huntersville,NC/ 28078
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: Fax:
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 is 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)
I b 5(A-1 1504MAw1 MAJAcTrn
Printed Name Title
Si nature Date
moski O1 , a Notary
Public of the Count. of tY\eCY.AtA , State of NOVite1C.CUOVV,hereby
certify that `LO r—}- bOV4 rtrtAil personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this 1 day of MaY0141 20 3 D.
Notary Signature: r`
tej 16 f?LIMy Commission Expires: a
Town of Huntersville
m -P� PO Box 664
6 o'0 co
105 Gilead Rd.,Ste 300
6 Huntersville, NC 28070
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