NCC220124_FRO Submitted_20220107

Citv of Charlotte & Mecklenburg County
V Soil Erosion and Sedimentation
Control Ordinance
F'inaneftil 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 filing this
form with the City of'Charlotte Engineer,ng and Property Management 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 rer.4ed documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. If the frnanciah- 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: Accent Berkeley Place
2. Address of land —disturbing activity: 10123 Berkeley Place Drive, Charlotte, NC 28262
3.
Approximate date land -disturbing activity will commence: October
Month
11 2021
Day Year
4.
Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5.
Approximate acreage of land to be disturbed or uncovered: 9.50
6.
List total site acreage: 11.66
7.
Landowners of Record (Use blank page to list additional owners):
Name: Accent Berkeley Place Charlotte LP, c/o Westplan Investors
Address: 3715 Northside Parkwav, NW, Building 400, Suite 375, Atlanta, GA
30328
'Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature:
Narne:
;'address:
'I'elephone: Fax:
(Area Code) (Area Code)
EImail Address:
Signature:
8.
]ndicate Book and Page where deed or instrument is filed (Use blank page to list
additional deeds or
instruments) Book 35726 page 537 Book
Page
Book Page Book
Page

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Accent Berkeley Place Charlotte LP, c/o Westplan Investors
Address. 3715 Northslde Parkway. NW. Building 400, Suite 375, Atlanta, GA 30328
Telephone:
(Area Code)
Finail Address:
ax:
(Area Code)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: CT Corporation S) stem
Address: 160 Mine Lake CourtSu,.e 200 Raleigh, NC 27615
Telephone: _ Fax:
(Area Coder
Email Address:
(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. (phis form mu be signed by the financially responsible person if an individual or by an
officer, director, partner, attorn-y-ih-fact, or other person with authority to execute instruments for the
financially responsible company or entity, if not an individual.)
Todd Cooper
Printed Name
S
I nme
Z_
of _ . state of,
cer•li,fi, that _
appeared hefore ine this dra3- rand uncles o.:1h acknowledge that this
Witness my hand rand ,l slur .s4wl, this (Z day n�f%%_
Nolen y Signalure. _
. L•C/
My Commission expiresI,��D (e
•
MARLOTTF_
VP of Construction
Title
Date
a Notary Public of 1ht Cuuntr
herehy
personally
jexecuted by him,her.
br [i1LX -' f 1 Cf'!
MANAG�M�NT
Land Development Division
600 East F jurth Street, Charlotte, North Carolina 28202-2844
Teiephone:704/336-6692 Fax: [phone]
http://landpermits.charmeek.org
SHARON R CHANDLER
NOTARY PUBLIC
Cobb County
Nty ConnS*sm tate F�Bs ?JO612421