NCC243318_FRO Submitted_20241029

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Mecklenburg County Soil Erosion and
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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: Bubbling Well Road-Lot 13, 14, 15
2. Address of land-disturbing activity: 406, 412, 416 Bubbling Well Road
3. Approximate date land-disturbing activity will commence: August 30 2024
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 1.42 ac (62,000 sf)
6. Total site acreage: 2.67 ac
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: SEE ADDITIONAL PAGE
Address:
Telephone: 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):
Lot 13 Book 38996 Page 277 Book 38821 Page 155 Lot 15
Lot 14 Book 39016 Page 753 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: Classica Homes, LLC
Address: 2215 Ayrsley Town Blvd, Suite G
Charlotte, North Carolina 28273
Telephone: [phone] Fax:
Email Address: [e-mail]
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: John Beddow
Address: 525 North Tryon Street, Suite 700
Charlotte, North Carolina 28202
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.)
Brian Hall Vice President
Printed Name Title
6. 8/14/2024
Signature Date
, hric[ Il 41/' -to 2- , a Notary Public of the
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County of -eL -I-' , s , State of /Vi(-I ( If '_ , hereby
%� n ll certify that /1 personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.Witness my hand and rial seal, this S r' y of UG Ial'-'r , 20 .21 / .
Notary Signature:
My Commission expires:
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t.o S Mecklenburg County Land Use and Environmental Services Agency
= Notary Public Z� 2145 Suttle Ave.
v Mecklenburg = Charlotte,NC 28208-5237
County Phone[phone]
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Owners
William & Laura Hicks (Lot 13)
12021 Heather Down Dr.
Herndon, VA 20170
Parcel — 22702797
Charsese Thompson (lot 14)
2900 Dexterity Ct.
High Point, NC 27265
Parcel —22702798
Thomas & Jessica Hull (Lot 15)
10400 Orchid Hill Lane
Charlotte, North Carolina 28277
Parcel — 22702788