NCC242953_FRO Submitted_20240925

a�kQ
,_`".... Mecklenburg County Soil Erosion and
F'+ 'ice '` ':1 Sedimentation Control Ordinance
r' r� Financial Responsibility/Ownership Form
ry Cwap"
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 Grading Lot 13
2. Address of land-disturbing activity: 6131 Joli Cheval Lane, Mint Hill, NC 28227
3. Approximate date land-disturbing activity will commence: 08 0115 2024
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): SF Residential House
5. Approximate acreage of land to be disturbed or uncovered: 2.50
6. Total site acreage: 4.485
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: Joe R. Jones and Marryanne P. Jones
Address: 520 Intracostal Drive
Fort Lauderdale 33304
Telephone: [phone] 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 38338 Page 775 Book Page
Book Page Book Page
(continue on back or separate pages as necessary)

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land-disturbing activity:
Person or Firm: Arcadia Homes, Inc.
Address: 2701 Coltsgte Road
Charlotte, NC 28211
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Jeremy Schumacher
Address: 2701 Coltsgte Road
Charlotte, NC 28211
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.)
Jeremy Schumacher President
Printed Name Title
ri./2
gnatt ,_. Daie
I iY\- , a Notary Public of the
County of Ar\�C�C -L���,,L , State of noy-H/A CrO , hereby
certify that 3��v-y� ‘-L�vj-GV LPL Iey--- personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal, this ac day of LJ l 1� ` , 20 .
�yI
Notary Signature �. - U3l,X 71074:44411wIto
My Commission expires: JLU ) oat-/ Atuno-±6Inquoppayy .b,rrn
eumoieo twoN ougnd AIeioN ' yr
4hIM N 313H0I1N
Mecklenburg County Land Use and Environmental Services Agency
2145 Suttle Ave.
Charlotte,NC 28208-5237
Phone[phone]