NCC241728_FRO Submitted_20240609

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r • Mecklenburg County Soil Erosion and
��' 1 ` Sedimentation Control Ordinance
°' Financial Responsibility/Ownership Form
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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: Davidson College
2. Address of land-disturbing activity: 205 Faculty Drive, Davidson, NC 28035
3. Approximate date land-disturbing activity will commence: November 01 2023
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Commercial - Football Stadium
5. Approximate acreage of land to be disturbed or uncovered: 3 Acres
6. Total site acreage: 221.2 Acres
7. Landowners of record(use blank pages to list additional owners as necessary):
Owner#1 Name: Trustees of Davidson College
Address: 209 Ridge Road, Box 5000, Davidson, NC 28035
Telephone: [phone] Fax:
Email Address:
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 11517 Page 417 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 fuzn(s) fmancially responsible for this land-disturbing activity:
Person or Firm: Trustees of Davidson College
Address: 209 Ridge Road, Box 5000, Davidson, NC 28035
I Telephone: [phone] Fax:
Email Address: daholthouseraAdavidson.edu
2. North Carolina agent for the person or Linn who is financially responsible:
Person or Fine:
Address:
Telephone: Fax:
1 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 fmancially 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.)
David Holthouser Director of Facilities and Engineering
Printed Name Title t.
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Signature Date
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before me this day and under oath acknowledged that this form was executed by him/her.
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