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HomeMy WebLinkAboutNCC243385_FRO Submitted_20241106 uu ° a I Mecklenburg County Soil Erosion and ' t Sedimentation Control Ordinance °R.,-.A,o ,? Financial Responsibility/Ownership Form 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: Connery Midfield Station Lots 2 &4 of Plat 2020114338 and Lot 2 of Plat 2022130054 2. Address of land-disturbing activity: 10825 Boykin Place & 10615 Surrey Green Lane MATTHEWS NC 28105 3. Approximate date land-disturbing activity will commence: December 29 2023 Month Day Year 4. Purpose of development(Residential, Commercial, Industrial, etc.): RESIDENTIAUCOMMERCIAL 5. Approximate acreage of land to be disturbed or uncovered: 10.90 6. Total site acreage: 34.83 7. Landowners of record (use blank pages to list additional owners as necessary): SEE PAGE 2 FOR ADDITIONAL LANDOWNERS Owner#1 Name: 1100 Matthews Mint Hill LLC Address: 1420 E 7th Street, Suite 150 CHARLOTTE NC 28204 Telephone: 704-817-9126 Fax: Email Address: wyatt@proffittdixon.com Owner#2 Name: MMU PH3 Property Owner LLC Address: 1420 E 7th Street Suite 150 Charlotte NC 28204 Telephone: 704-817-9126 Fax: Email Address: wyatt@proffittdixon.com 8. Indicate Book and Page where the deed or instrument is filed(use blank pages to list additional deeds or instruments as necessary): Book 36619 page 900 Book 37649 Page 475 Book 32563 page 296 Book Page (continue on back or separate pages as necessary) Form Revised 12-2016 ADDTIONAL LANDOWNERS OF RECORD OWNER#3: USCMF BRILEY LP ADDRESS: 333 WEST WACKER DRIVE, 28TH FLOOR CHICAGO, IL 60606 PAGE 2 Continue - Financial Responsibility/Ownership Form PART B 1. Person(s) or firm(s) financially responsible for this land-disturbing activity: Person or Firm: 1100 Matthews Mint Hill LLC Address: 1420 E 7th Street, Suite 150 CHARLOTTE, NC 28204 Telephone: 704-817-9126 Fax: Email Address: wyatt@proffittdixon.com 2. North Carolina agent for the person or firm who is financially responsible: Person or Firm: Wyatt T. Dixon Address: 1420 E 7th Street, Suite 150 Charlotte, NC 28204 Telephone: 704-817-9126 Fax: Email Address: wyatt@proffittdixon.com 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.) �Ika ►.f N1UY�(����� Printed ame Title 116023 Signatt(re �� Date UU - I, Katie n'1 1 ' i 1 Q s Cran e , a Notary Public of the County of lk.40 (1 , State of 00(4 )12.r01 i n t� , hereby certify that Y a D 1 O►'l personally appeared before me this day and under oath acknowledged that this form wasas executed by him/her. Witness my hand and notarial seal,this t 11 day of SQ "1 ber ,20 023 Notary Signature: I My Commission expires: ja-n e des Mecklenburg County Land Use and Environmental Services Agency KAREN THIES CRANE 2145 Suttle Ave. NOTARY PUBLIC Charlotte,NC 28208-5237 Mecklenburg County Phone(980)314-3234 North Carolina My Commission Expires June 23,2025