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HomeMy WebLinkAboutNCC233364_FRO Submitted_20231117 6V r`'. Mecklenburg County Soil Erosion and . i,� Sedimentation Control Ordinance s M C: 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: Royal Bliss Brewing 2 2. Address of land-disturbing activity: 20607 Harbor View Drive Cornelius, NC 28031 3. Approximate date land-disturbing activity will commence: 10 20 2023 Month Day Year 4. Purpose of development (Residential, Commercial, Industrial, etc.): Commercial 5. Approximate acreage of land to be disturbed or uncovered: 1.55+/- acres 6. Total site acreage: 2.98+/- acres 7. Landowners of record(use blank pages to list additional owners as necessary): Owner#1 Name: Griffin Bros Acquisitions LLC Address: 19109 W Catawba Ave Suite 110 Cornelius, NC 28031 Telephone: 704-201-4447 Fax: Email Address: larryjr@griffinbros.com Owner#2 Name: 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 35742 Page 278 Book Page Book Page 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) financially responsible for this land-disturbing activity: Person or Firm: Griffin Bros Acquisitions LLC (Larry Griffin, Jr.) Address: 19109 W Catawba Ave Suite 110 Cornelius, NC 28031 Telephone: 704-201-4447 Fax: Email Address: larryjr@griffinbros.com 2. North Carolina agent for the person or firm who is fmancially 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.) L-CoNA\ CA--.,-.4--t) , -9fi*!Wilt",r Printed N Title 3 ..\3.4\ (703 Signature Date I, , lu he! t T t )I')c4-{ , a Notary Public of the County of m e(ml Du ivC , State of NC C , hereby certifythat c 6,-;ry; l i V-• personally appeared 1 rr� � before me this day and under oath acknowledged that this form was executed by him/her. Witness my hand and not ' ea t ' 0, day of S#p,(,,t b V- , 20 2-_3 . Notary Signature: C ,4 My Commission expir /— 2-& —Z �,s``t 9,0 P W f,,i 1 oyritAk os Mecklenburg County Land Use and Environmental Services Agency :C Z 2145 Suttle Ave Vic)* Ati8L.G 4.-`Charlotte,NC 28208 5237 • .ti ,�� Phone(980)314-3234 •e F.t~"""' �� �ti44'URGG � ` "III"