NCC241803_FRO Submitted_20240618

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land-disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: The Vines Subdivision - Road Improvements
2. Address of land—disturbing activity: 9747 Notebook Trail, Charlotte, NC 2821
3. Approximate date land-disturbing activity will commence: July 1, 2024
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential Development
5. Total acreage of land to be disturbed or uncovered: 4 Acres
6. List total site acreage: 56.1 Acres
7. Landowners of Record(attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: KW-HS Lot Option Pool 01 LLC- c/o Hearthstone, Inc.
Address: 23975 Park Sorrento Ste 220, Calabasas, CA 91302
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Name:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 38520 Page 986 Book Page
Boo Page Boo Page
Page

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land-disturbing activity(Note:If the financially responsible
person(s) or.firm(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: Lennar Carolinas, LLC
Address: 6701 Carmel Road, Suite 425
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: Mark.Henninger@a,lennar.com
If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm: Corporate Creations Network Inc.
Address: 15720 Brixhaw Hill Avenue#300
Charlotte, NC 28277
Telephone: Fax:
(Area Code) (Area Code)
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.)
Mark Henninger Division President
Printed Na Title
Date
Signature ,.
I
f VI(e-e(, G-" ,-----
I, v,/f Q - , a Notary Public of the County
of LI f) / , State of /i11 Clr•'7'l ,n) , hereby
certify that r.,re/ 4 cry) t/t Pr- 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 •{
Notary Signature:
My Commission expires: `.5 / Li/ —7
/ • KATNHLEEN G.OT(CO) ARY PUBLIC
Union County
No Carolina
My Commission
rth Expires May 4,2027
OMMIIIIMID S,,
charlottenc.gov
Storm Water Services—Land Development
600 East Fourth Street,Charlotte,North Carolina 28202-2844
Telephone: [phone]
http://charlottenc.gov/developmentcenter
Page 2
Rev.09/2021