NCC216619_FRO Submitted_20211130

City of Charlotte & Mecklenburg County
Soil Erosion and Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity covered by Chapter 17, Article 2 of the Charlotte City Code or
Section 6 of the Mecklenburg County Sedimentation and Erosion Control Ordinance prior to completing and fling this
form with the City of Charlotte Engineering and Property Managentent Department, Land Development Services Division
or Mecklenburg County Land Development Services. The financial responsibility 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.
Please Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Foxcroft Place
2. Address of land —disturbing activity: 2401 Sharon Lane
Charlotte, NC 28211
3. Approximate date land -disturbing activity will continence: 12 01 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 3.1 (includes off -site area for utility connections)
6. List total site acreage: 3.06
7. Landowners of Record (Use blank page to list additional owners):
Name: Sharon Lane, LLC
Address: P.O. Box 2026
Greenville, SC 29602
Telephone: [phone] Fax:
(Area Code)
Email Address: [e-mail]
Signature:
Name:
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 35450 Page $5 Book Page
Book Page
Book Page
Page t

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm
Address:
Sharon Lane, LLC dba Foxcroft Place, LLC
1221 Hawthorne Lane
Charlotte, NC 28205
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
ax:
(Area Code)
3. The above information is true and correct to the best of my knowledge and belief and was provided by me
while under oath. (Thus form must be signed by the financially responsible person if an individual or by an
offic r, director, partner, attorney -in -fact, or other person with authority to execute instruments for the
final ially responsible company or entity, if not an individual.)
RobertjHar)�y
Printed N
Signature
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cert i� that
Member
Title
NO1/ z� 4�1
Date
a Notary Public of the County
.Mate Of hereby
Personally
appeared before me this day and under oath aclnlowledge that this fornn was executed by hire/her.
Witness n1y hand and notarial seal, rr o�3 � dory of 20
Notary signature: � B
lily Conlnnssion expires: 9ZOZ ' hi; eunf E„„
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On Expires
June 21, 2026
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OURUGM
ENGINEERING &PROPERTY
MANAGEMENT
Land Development Division
3426(%0 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax, 704/336-6586
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