NCC243550_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: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
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: [phone] Fax:
(Area Code) (Area Code)
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.)
�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: [phone]
http://charlottenc.gov/developmentcenter
Rev.09/2021 Page 2