NCC220249_FRO Submitted_20220112

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 filing this
form with the City of Charlotte Engineering 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 related documents for any non-compliance of the City of Charlotte Soil Erosion and
Sedimentation Ordinance. If the financially responsible parry 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
Villages at Eastway
2. Address of land —disturbing activity: 301 Eastway Drive, Charlotte NC 28213
Approximate date land -disturbing activity will commence:
Feb. 01
2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
Approximate acreage of land to be disturbed or uncovered: 6.00 ac
6. List total site acreage: 4.628 ac
7. Landowners of Record (Use blank page to list additional owners):
Name: Eastway Harmony Housing, LLC
Address: 4025 Lake Boone Trail, Suite 209
Raleigh, NC 27607
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
Name:
Address:
Telephone: Fax:
(Area Code)
Email Address:
Signature:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 20143 Page 254
Book Page
Book Page
Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
I. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Eastway Harmony Housing, LLC
Address: 4025-Cake Boom Trail, Suite 209_
. ..... Raleigh. NC 27607
Telephone: [phone] --- Fax:
(Area Code) (Area Code)
Email Address: Ln.purinai&qreyco.cc)m
2. -North Carolina agent, for the person or firm who is financially responsible:
Person or Firm. Eastway Harmony Housing, LLC
Address: 4025 Lake Boone Trail, Suite 209
Raleliqh, NC 27607
Telephone:_1919) 744-27-51 tax
(Area,Code) (Area Code)
Email Address: _ion .Purin@IMa_gre com
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.)
Jon Purinai
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Signature
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MY Commission expires.-
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Land Development Division
600 East fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
liftp,/Ilaiidpermits.char.meek-.org
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