NCC232483_FRO Submitted_20230816

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: Cardinal Creek Subdivision
2. Address of land—disturbing activity: 11615 Plaza Road Extension
Charlotte, NC 28215
3. Approximate date land-disturbing activity will commence: November 07 2022
Month Day Year
4. Purpose of Development(Residential, Commercial,Industrial, etc.): Residential
5. Total acreage of land to be disturbed or uncovered: ± 60.0
6. List total site acreage: 64.9
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: Betty Anne Cardinal Hough
Address:8421 Annette Avenue Mint Hill NC 28227
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Name: City of Peace Ministry, Inc.
Address: 11301 Plaza Road Extension, Charlotte, NC 28215
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 2237 Page 513 Book Page
Book 2236 Page 545 Book Page
Page 1

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: Eliseo Pasqual-Baez
Address: 11237 Plaza Road Extension, Charlotte, NC 28215
Telephone: Fax:
(Area Code) (Area Code)
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: D.R. Horton, Inc.
Address: 8025 Arrowridge Boulevard, Charlotte, NC 28273
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]; [e-mail]; [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 Mire Lake Court, Suite 200, Raleigh NC 27615
Telephone:[phone] Fax:
(Area Code) (Area Code)
Email Address:[e-mail]
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.)
George Bartley Carroll NPDES Manager
Print, ame Title
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Signal Ire Date
I, L°CAN 'roST_1Q. V^E ,H , a Notary Public of the County
of Ater,kl` 41 647' , State offOrtk CInrUli n , hereby
certib)that L SA e7 Cc rt'b'(I personally
appeared before this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this day of KrlG _ . 20 22,
Notary Signature: /-�
My Commission ex es: g 2- /
•
CO) LOGAN F. CREECH
Notary Public, North Carolina
Mecklenburg County
My Commission Expires
March 03,2027
charlottenc.gov
Storm Water Services—Land Development
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone: [phone]
http://charlottenc.eov/developmentcenter
Rev.09/2021 Page 2