NCC232827_FRO Submitted_20230920

qSMecklenburg County Soil Erosion and
)
edimentation Control Ordinance
3 , .. Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity covered by Section 6 of the Mecklenburg
County, Mint Hill or Davidson Sedimentation and Erosion Control Ordinances prior to
completing and filing this form with Mecklenburg County Land Use and Environmental
Services. The financially responsible party will be on record as the party to accept any Notices
of Violation or related documents for any non-compliance with the above Ordinances. 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: Euroline
2. Address of land-disturbing activity: 9540 Rodney Street
Pineville, NC 28134
3. Approximate date land-disturbing activity will commence: October 1 2022
Month Day Year
4. Purpose of development(Residential,Commercial,Industrial,etc.): Industrial(logistics)
5. Approximate acreage of land to be disturbed or uncovered: 5.88 Acres
6. Total site acreage: 7.39 Acres
7. Landowners of record!' la
(use blank pages to list additi nal owners as necessary):
Owner#1 Name: 7 fi1 L r i Se goxi-rl.�
Address: /�1 �G// zaa4 t2OA-eS At
Ala//vi ti, NC, 2eri 3
Telephone: Egg 949 69/3 earl• 997 Fax:
Email Address: -CV,07"A" y4�.Qo_ COI1
Owner#2 Name: �1
Address:
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 36915 Page 329 Book 03386 Page 173
Book 36762 Page 699 Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue-Financial Responsibility/Ownership Form
PART B
1. Person(s)or firm(s)financiallyllr responsible for this land-disturbing activity:
Person or Firm: //L/ LLj�C/I, 2/Li ie5
Address: I,/i 5i a,e U/ 0oh•[5 At
/Gfu�vile /VCR l t/ 3
Telephone: (. 6 9 6 9/3 h -3-7 Fax:
Email Address: SI/,02141-7 4Pe. Co
2. North Carolina agent ror me person or firm who is financially responsible:
Person or Finn:
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 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.)
$E1&' Q4f.2he4-
Printed Name - Title
p3//9/2602
Signature Date
1, J 1I( I-I l �C� j�S ,a Notary Public of the
Count, L,,� U�.I e , State of I�.�0 H h (1�G c (L.r hereby
h �Q
t 1 �0„,, vq-e R personally appeared
d m e 'd‘say Ad under oath acknowledged that this form was executed by him/her.
.� a
itp6.1-A andi • •tarial seal his 7 day of --few L/,L. 20 'L2_ .
Nott lgigtur&�1."° CA
t ritnia ire .
d o
( -� ' C �,,
Mecklenburg County Land Use and Environmental Services Agency
2145 Suttle Ave.
Charlotte,NC 28208-5237
Phone[phone]