NCC215057_ESC Approval Submitted_20210908

,�y� Town of Huntersville
vj�aiwn of •
le Soil Erosion &Sedimentation Control Ordinance
` ORTH CAROLTNA Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity as defined in the Town of Huntersville Soil
Erosion and Sedimentation Control Ordinance prior to completing and filing this form with the Town
of Huntersville. The financially responsible party will be on record as the party to receive any
Notices of Violation or related documents related to non-compliance issues with the above
Ordinance. By filing this form, the parties are not relieved from any other permits that may be
required for the Project. 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: Album Huntersville
2. Address of land -disturbing activity. 4464 Hylas Lane Huntersville, NC 28269
3. Approximate date land -disturbing activity will commence: June
Month
4. Purpose of development (Residential, Commercial, Industrial, etc.). _
5. Approximate acreage of land to be disturbed or uncovered. 7.45 AC
6. Total site acreage: 5.88 AC
1 2021
Day Year
Commercial (Multifamily)
7. Landowners of record (use blank pages to list additional owners as necessary)
Owner #1 Name: CRP-GREP Album Huntersville Owner, LLC
Address. 521 E Morehead St #400, Charlotte, NC 28202
Telephone. [phone]
Email Address: [e-mail]
Owner #2 Name-
Address-
Telephone -
Email Address:
Fax: N/A
Fax:
8. Indicate Book and Page where the deed or instrument is filed (use blank pages to list
additional deeds or instruments as necessary)
Book 36321 Page 493 Book Page
Book Page Book Page
11/19

Financial Responsibility/Ownership Form - Continued
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Persons or Firm: CRP-GREP Album Huntersville Owner, LLC
Address: 521 E Morehead St. #400, Charlotte, NC 28202
Telephone:
704-379-1868
Email Address: [e-mail]
Fax: NIA
2. North Carolina agent for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
Email Address:
Fax:
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 is 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)
Josh Glover
Printed Name
I
Sign
Zt:�
I
Vice President
Title
812121
Uaie
, a Notary
Public of the County of 1' &AI t n buwr! State of Nor 441 e&`D 1 +v« , hereby
certify that Josh Glover personally appeared
before me on this day and under oath acknowledged that this form was executed by him/her.
Witness my hand and no3iai seal, 2 n4 day of August 2021
Notary Signature:
My Commission
��•t�' �8 SFr ea *,��
Town of Huntersville
P❑ Box 664 _ ilotd,
105 Gilead Rd., Ste 300
Huntersville, NC 28070 do
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