NCC243271_FRO Submitted_20241025

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: Woodfield Lakeside
2. Address of land—disturbing activity: 16101 & 16315 York Road, Charlotte, NC 28278
3. Approximate date land-disturbing activity will commence: August 25 2020
Month Day Year
4. Purpose of Development(Residential, Commercial, Industrial, etc.): Commercial -- Multifamily
5. Approximate acreage of land to be disturbed or uncovered: 23 ac
6. List total site acreage: 27.46 ac
7. Landowners of Record(Use blank page to list additional owners):
Name: Highway 49 Ventures (PIDs - 21734101 & 21734108)
Address: 5615 Potter Road
Matthews, NC 28104
Telephone: 7o L(' •- B 70 — '6 I0 Fax:
(Area Code) (Area Code)
Email Address: Otevii.. /CYO- ; A — y-Co r►-A
Signature:
Name: Robert G Spratt III (PID 21734109)
Address: 2601 Hampton Ave
Charlotte, NC 28207
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 31089 Page 68 Book Page
Book 31355 Page 777 Book Page
Page 1

City of Charlotte & M.ecklenburg 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 fnginccnns 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 he undertaken: Woodfield Lakeside
2. Address of land disturbing activity: 16101 & 16315 York Road, Charlotte, NC 28278
Approximate date land-disturbing activity will commence: August 25 _ 2020
Month Day Year
4. Purpose of Development(Residential. Commercial. Industrial-etc.):Commercial - Multifamily
5. Approximate acreage of latter to be disturbed or uncovered: 23 ac
6. List total site acreage: 27.46 ac
7. Landowners of Record(I!se blank page to list additional owners):
Name: _ Highway 49 Ventures (PIDs - 21734101 & 21734108)
Addre-ti:: 5615 Potter Road
Matthews, NC 28104
Telephone: _Fax:
(Area Code) (Area Code;
Email Address:
—
—
Signature:
Name: Robert G Spratt III (PID 21734109) — —
Address: 2601 Hampton Ave
Charlotte, NC 28207
Telephone: C 1 0 \1 Li 7 "7- 5O4'L Fax: NO
NA-
( 1J
t A1rra Coda (Area Cock)
Email te _IA •f, ? P . �rD».�
Si iattire: ,, 'IIll- /� ��
8. Indicate Book and Page where deed or instrument is tiled (Lse blank page to list additional deeds or
instruments) Book 31089 Page 68 Rook Page _
I3ook 31355 Page 777 - Book_ Pale
Part:1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s)
financially- responsible for this land-disturbing activity:
Person or Firm: Wes"Qll he 0:$ 1°AS 1 /1 C
Address: -MI {a;cv ►Cd, 32 l chow/ Nc, 282a(p
Telephone: "WI- Stop-.27g3 Fax: Nf14
(Area Code)) (Area Code)
Email Address: c ��e.r VAIO-ed Y1-e±
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
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.)
CiAote) 0. ail& ,16961-
Printed Name Title
3N20
4/A., Y.----
by
Signature
//,�,,,,,�� /� � � Date
I, a ✓Y ' , a Notary Public of the County
of jp.ae 2LAAt- , State of fedfi ( 1/h.ICJ , hereby
certify that ( had -ML 0 i,1 (114 personally
appeared before me this day and under oath ac-howledg e that this fOrm was executed by him/her.
Witness my hand and notef(ial seal, this I �h day of �/l NL� , 20 0�C/
Notary Signature.4 -k , 1�y; alb
My Commission expire. 4/ /gj/ .23
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BEY N CM
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ii. r vv... A/�y v CHARLOTTE_
Eci —• zit ENGINEERING&PROPERTY
_rn G I 'i MANAGEMENT
s°%;,PU B1.\ :'� Land Development Division
600 East Fourth Street,Charlotte,North Carolina 28202-2844
,,`... aURG.G�, '.,`, Telephone: [phone] Fax: [phone]
������umsS'...... http://landpermits.charmeck.org
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