NCC241524_FRO Submitted_20240610

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Mecklenburg County Soil Erosion and
E ` Sedimentation Control Ordinance
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t^ : 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: Cheval Lot 123
2. Address of land-disturbing activity: 4246 Piaffe Avenue, Charlotte, NC 28277
3. Approximate date land-disturbing activity will commence: June 1 2024
Month Day Year
4. Purpose of development(Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 0.7
6. Total site acreage: 0.95
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: Manan & Timsy Vora
Address: 2704 Piersland Drive
Matthews, NC 28104
Telephone: Fax:
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 38023 Page 420 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: Paragon Homes of Charlotte, Inc.
Address: 600 Towne Centre Blvd, Suite 403
Pineville, NC 28134
Telephone: [phone] Fax:
Email Address:
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Mitchell Genda
Address: 9200 Ardrey Woods Drive
Charlotte, NC 28277-8474
Telephone: [phone] Fax:
Email Address: [e-mail]
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.)
Mitchell Genda President
Printed Name Title
Signature Date
I, iii'IMt 644114... 6dreforQ , a Notary Public of the
County of YoY IL. , State of .S( , hereby
certify that Ml ( Cl-c rice( personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand a n tarial se ,thi 2 9 day of 41:21 r I , 20 „lg. .
Notary Signature: c f al
My Commission expi es: IP-4 r� ,�►arie• (�'•.,,
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Mecklenburg County Land Use and Environmental Services Agency Ii ��( + :
2145 Suttle Ave. a ��
Charlotte,NC 28208-5237 '. � `'-� ,•
Phone[phone] s �•:' ; I