HomeMy WebLinkAboutNCC220951_FRO Submitted_20220307City 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.
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PART A
1. Project where land -disturbing activity is to be undertaken: Trevi Village Multi -Family
2. Address of land —disturbing activity:12220 U.S. Highway 29, Charlotte NC 28262
Approximate date land -disturbing activity will commence:
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 6.13 Acres
6. List total site acreage: 6.19 Acres
7. Landowners of Record (Use blank page to list additional owners):
Name: Murphy VAT, LLC
Address: 6514 Deane Hill Drive, Knoxville TN, 37919
Telephone: 865-558-0577 Fax:
(Area Code)
Email Address:
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 37018 Page 653 Book 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: Murahv VAT. LLC
Address: 6514 Deane Hill Drive Knoxville TN 37919
Telephone: 865-558-0577 Fax: 251-450-2788
(Area Code) (Area Code)
Email Address:
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: ColeJenest & Stone, PA
Address: 200 South Tryon Street, Suite 1400, Charlotte, NC 28202
Telephone: 704-971-4510 Fax:
(Area Code) (Area Code)
Email Address: cjenestgcolejeneststone.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.)
�i
Printed Name 8 Title
Signature
I,
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Date IV
a Notary Public of the County
�J of Y\ ® )( 1j State of 'T.L !A vx e S.S e .e. , hereby
certify that To k n A- My Grp k q personally
appeared before me this day and under oath acknowledge that this form was executed by him/her.
Witness my hand and notarial seal, this ` ' day of F-- L r" a q 20 7- Z -
Notary Signature:
My Commission expires: j / �/ , a0d-5— U
'.NE M. 41 _
STATE
OF
TENNESSEE
NOTARY
PUBLIC
CUMLOTTEW
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone:704/336-6692 Fax: 704/336-6586
http://Iandpeiinits.charineck.org
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