NCC220579_FRO Submitted_20220207

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 party is out of State, a North Carolina agent must be assigned.
Please Type or Print
PART A
Multifamily apartment development located off of
1. Project where land -disturbing activity is to be undertaken:
W. Arrowood Rd & Johnston Lake Dr. (PID 2013010
2. Address of land —disturbing activity: NA
3. Approximate date land -disturbing activity will commence: 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 24.00 Acres
6. List total site acreage: 36.58 acres
7. Landowners of Record (Use blank page to list additional owners):
Name: Hawthorne at Whitehall Apartments, LLC
Address: 806 Green Valley Road, Suite 311
Greensboro, NC 27408
Telephone: Fax:
ea C (Area Code)
Email Address:
Signature:
Name:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Signature:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36253
Book
Page 101
Page
Book Page
Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Evolve Companies
Address: 2012 Eastwood Rd Wilmington NC 28403
Telephone: [phone] Fax:
(Area Code)
Email Address:
(Area Code)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone: r ax:
(Area Code) (Area Code)
Email Address:
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 co p y entity, if not an individual.)
RCtV�Ckgl -ems
Printed Name Title
Signature Date
a Notary Public of the County
Of III(/(Q V{ V State o eptI10 hereby
certify that t I personally
appeared before me this day and under oath acknorX1 dge that this form was executed by himAer.
Witness my hand and notar.al seal this �/ day o 20
Notary Si ature-
No ry gn
My Commission expires: ©g— 03
•
C HARMTTE_
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpennits.charmeck.org
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