NCC241053_FRO Submitted_20240409

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity covered by Chapter 17,Article 2 of the Charlotte City Code or Section
6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and filing this form with
the City of Charlotte Engineering and Property Management Department, Land Development Services Division or
Mecklenburg County Land Development Services. The financial responsibility 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.
Please Type or Print
PART A
1. Project where land-disturbing activity is to be undertaken: Edenbrook
2. Address of land—disturbing activity: Rebecca Ave. (Bldg. 1020,Lots 97- 103)
3. Approximate date land-disturbing activity will commence: June 2024
Month Day Year
4. Purpose of Development(Residential, Commercial,Industrial, etc.): Residential(Townhomes)
5. Approximate acreage of land to be disturbed or uncovered: 0.24 ac.
6. List total site acreage: 10.1 ac.
7. Landowners of Record(Use blank page to list additional owners):
Name(1) : Rebecca Development,LLC
Address: 6200 Glynmoore Lakes Dr.
Charlotte,NC 28277
Telephone: [phone] Fax: NM
(Area Code) (Area Code)
Email Address: chksalehAemail.com
Signature: See Authorization Letter from Owner
Name(2):
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
8. Indicate Book and Page where deed or instrument is filed(Use blank page to list additional deeds or
instruments) Book 38003 Page 755 Book Page
Book Page Book Page
Page I

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s)or firm(s) financially responsible for this land-disturbing activity:
Person or Firm: NVR,Inc. (dba Ryan Homes)
Address: 10720 Sikes Place,Suite 300
Charlotte,NC 28277
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: tsearsAnvrinc.com (Travis Sears)
2. North Carolina agent,for the person or firm who is financially responsible:
Person or Firm: Corporation Service Company
Address: 2626 Glenwood Avenue,Suite 550
Raleigh,NC 27608
Telephone: [phone] Fax: N/A
(Area Code) (Area Code)
Email Address: sitvla.hill a,CSCGlobal.coin
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.)
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3.2-7. ZA
Sign. Date
Off/ U.'•_A a Notary Public of the County
of (An ',lD n
�" , State of �OH-� �V f VlA— , hereby
cert� �1 that 7C)✓1 A- - 1. 1 1-teS5 personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this day of Y14WCh , 20
Notary Signature:
My Commission expires: �1w' h W l 90, ��pQ\ MCCU��'�.,,
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CHARLifiTE•
ENGINEERING amateur
• MANAGEMENE
Land Development Division
600 East Fourth Sheet,Charlotte,North Carolina 28202-2844
Telephone:[phone] Fax:[phone]
http://landpermits.charmeck.org
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