NCC241039_FRO Submitted_20240408

Mecklenburg County Soil Erosion and
E� : Sedimentation Control Ordinance
$ :
GA" 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: Dan Hood Subdivision
Minor Grading Permit
2. Address of land-disturbing activity: 3351 Dan Hood Road, Matthews NC 28105
3. Approximate date land-disturbing activity will commence: November 5 2022
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 24.05 acres
6. Total site acreage: 26.56
7. Landowners of record(use blank pages to list additional owners as necessary):
Owner#1 Name: Dhanesh Kumar
Address: 215 North Pine Street, Unit 3026, Charlotte NC 28202
704-550-1652 Fax: N/A
Telephone:
Email Address: [e-mail]
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 37257 Page 267-269 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART 11
1, Person(s) or firm(s) financially responsible for this land-disturbing activity:
Person or Finn: Dhanesh Kumar
Address: 215 North Pine Street, Unit 3026, Cha71otto, f C 28202
Telephone: [phone] Fax: N/A
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone: lax:
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.)
Dhanesh Kumar Managing Director of Kinger Homes
Pn fled Name ,, / Title
0P5/2022
Swan are Date
1, 1)0 0{Y10,44'1 oA , a Notary Public of the
County of (-0 ittrrn 11-420c State of 6104
, hereby
certify that Dk.tDe-sk X `w Y personally appeared
before me this day and under oath acknowledged that this form was executed by hini her.
Witness my hand and notar l seal, this 0 c day of MI ,
Notary Signature: Vki r '�+y
My Commission expires: 4;•"t' ';e ti
• tdkruf s
, GEORGLk
Mecklenburg County Land Use.and Environmental Services Agency Ncio•,,pt,130;•,`a a'
I45 Sunk Ave, y.,,yw,81A
fC � •• o
Charlotte, NC 2S2O5.5237 G J.
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Phone(9S0)314-3234