NCC243588_FRO Submitted_20241120

Mecklenburg County Soil Erosion and
ffikM Sedimentation Control Ordinance
1.
Financial Responsibility/Ownership Form
CA
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
I. Project where land-disturbing activity is to be undertaken: lnpro Clear Creek
2. Address of land-disturbing activity: 10681 Clear Creek Commerce Drive
Mint Hill, NC 28227
3. Approximate date land-disturbing activity will commence: June 1 2024
Month Day Year
4. Purpose of development (Residential, Commercial, Industrial, etc.): commercial
5. Approximate acreage of land to be disturbed or uncovered: 10.27
6. Total site acreage: 10.43
7. Landowners of record (use blank pages to list additional owners as necessary):
Owner#1 Name: Z.t.EA, e F-Amiq r264-t_ E5T/I-Te,L.CC
Address: ca)3S-i S ROAD
06,0(00 rt4 0 ut.) 5-30
Telephone: 104-A44-lcac, Fax:
Email Address: EA z-ie4Lete.c..) CattA...
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):
Book 36897 Page 55 Book Page
Book 69 Page 899 Book Page
(continue on back or separate pages as necessary)
Form Revised 12-2016

Continue - Financial Responsibility/Ownership Form
PART B
I. Person(s)or firm(s) financially responsible for this land-disturbing activity:
Person or Firm: Inpro Interiors Corporation
Address: 18301 Mainsail Pointe Drive
— Cornelius, NC 28031-5201
- -
Telephone: '7 0 - I 1-1-—71 2 leo Fax:
Email Address: EA if drit-ez iluAzzcole-P, Co144
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm: Eric Ziegler
Address: 18301 Mainsail Pointe Drive
Cornelius, NC 28031-5201
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.)
5-rep#63 Z( A tAA6Ant -12--
Printed Name Title
42140Y
Signature Date
r‘' Slf1/1.1 ti< , a Notary Public of the
County of 1,4 ) et A...) , State of L.J s c)v) s , hereby
certify that ( e—pkevi Z4'ec; 1 cr personally appeared
before me this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and notarial seal,this CO-21 day of ,3 'L.) e ,_20
,4wimmike----ti. •
Notary Signature: 2JLLi
KIXS;Y PU,6
My Commission expires: 5'1 rn 1.4
* KRISTINE K. *I
EU IS
Mecklenburg County Land Use and Environmental Services Agenik(1:2,
2145 Suttle Ave. leCc,7:7CCP"
Charlotte,NC 28208-5237
Phone[phone]