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HomeMy WebLinkAboutNCC243550_FRO Submitted_20241118 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 PART A 1. Project name: CLYDE BUNGALOWS 2. Address of land-disturbing activity: CLYDE DR, CHARLOTTE, NC 28208 3. Approximate date land-disturbing activity will commence:SEPTEMBER 1 2024 Month - Day_ Year 4. Purpose of Development(Residential, Commercial, Industrial, etc.):RESIDENTIAL 5. Total acreage of land to be disturbed or uncovered: 1.86 ACRES 6. List total site acreage: 1.96 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:TEXAS FOREVER, LLC Address: 100 BACON AVE CHARLOTTE NC 28208 Telephone: Fax: (Area Code) (Area Code) Email Address: Name:CECIL & SANDRA RHODES Address:4813 CHEVIOT RD CHARLOT-TE-N-28269 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 37583 page 441 Book 05358 Page 541 Book 05632 page 630 Book Page Page 1 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(,) or firm(s)has an out-of-state address, a North Carolina agent must he designated in item 2 below): Person or Firm: Pulte Home Company, LLC Address: 11121 Caramel Commons Blvd, Suite 450 Charlotte, NC 28226 Telephone: 704-430-9392 Fax: (Area Code) (Area Code) Email Address: daniel.rossi@pultearoup.com 2. 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: Corporation Service Company Address: 327 Hillsborough Street Raleigh, NC 27603 Telephone: 704-430-9392 Fax: (Area Code) (Area Code) Email Address: daniel.rossi@pultegroup.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.) �G�1 e_k -crs'\ .if flF Iran r1Cinn1nc5-r'(kV.- 10 Printed N Title r m.en4 11 11 ( 2'+ Sign re I Date I, L.Qiu'c-t c � ,k( c -. , a Notary Public of the County of IV\EC'\CnkoLA\r-o) , State of NJor-v 1 C ck.,c6 I r \C\ , hereby certify that TM CA'Th\&.\ sg.bs5\ personally appeared before me this day and under oath acknowledge that this form was executed by him/her. Witness my hand and iotarial seal, this \ `tr day of NOV tlY1b , 20 2/ Notary Signature: IO J \- \ \A ,,,",,.,,,,,��,,..I„I,, —` N UTTE My Commission expires: )0 2C'ij 2 ' i•`... •••• �.. • (0)) _ NOTARy L i i Ei C.. • 'UBUG ? .Z S. charlottenc.gov Storm Water Services—Land Development 600 East Fourth Street, Charlotte,North Carolina 28202-2844 Telephone: 704/3 3 6-6692 http://charlottenc.gov/developmentcenter Rev.09/2021 Page 2