NCC220449_FRO Submitted_20220125

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 tiling 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 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;
Wildwood
2. Address of land -disturbing activity: 15627 Thomas Road, Charlotte, NC 28278
3. Approximate date land -disturbing activity will commence: September
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 21
6. List total site acreage: 25
7. Landowners of Record (Use blank page to list additional owners):
Name: Lewis Bartles / Dandaloo Limited Partnership
Address: 7109 Anchorage Lane, Tega Cay, SC 29708
Telephone: [phone]
(Area Code)
Email Address: bartl01 iii)vahoo.com
Signature:
Name:
Address:
Telephone:
(Area Code)
Ernail Address:
Fax:
Fax:
kru cu V uuc I
(Area Code)
1
Signature:
Indicate Book and Pa-e where deed or instrument is tiled (Use blank page to list additional deeds or
instruments) Book 33388 Page
Boo
Page
378
Book Page
Book Page
2021
Year
111we r

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or tirtn(s) financially responsible for this land -disturbing activity:
Person or Firm: AMH NC Development, LP
Address: 16905 Northcross Drive Ste 200, Huntersville, NC 28078
Telephone: [phone] Fax:
(Area Code)
Email Address: tmanninq[u)ah4r.com
(Area Code)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:Travis Manning
Address: 16905 Northcross Dr. Suite 200 Huntersville NC 28078
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: tmanning( ah-lr.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.)
Travis )ytanning Land Development Manager
Printed Nam Title
�/� 5/18/1-1021
Signature Date
N\eA a Notar-i- Public of the Count.l.
of 1 re d s0 U�� State ot'_ Nor" �1r� � 1 �lb� hel-eb.l'
c ertifi• that
appeared bc.,f nv ine this daY and under oath
rle(,(ge that this.161m eras cm,c•utc d hr him/her.
personalll.
11'ltnc'ss mY hand and notarial.yeal, this• �` clay of M co4 . 20 Z 1
Notary Signature S * ,,�111f�,
All- Connni. sion cwph-('v: _ 0 8 ' 2 8 ' ZOZ3
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ENGINMANAGEMENi PROPERTY '/,,, L,�O�
Land Development Division
600 East Fourth Street. Charlotte. North Carolina 28202-2844
Telephone:[phone] Fax:[phone]
http://landpennits.cllarnleck.or�� Niue 2