NCC222513_FRO Submitted_20220713

DocuSign Envelope 113:421B71C6-CCE0 4E45-BEW-47139C00113868
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 Cade 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.
Tease Type or Print
PART A
1. Project where land -disturbing activity is to be undertaken: Hennigan Place
2. Address of land —disturbing activity 35,4.1, 3....29 3505. 3605 3615 3545 3603 3415 3537 3533
Tilley Morris Road, Matthews, NC 28105 and Parcel ID 23111445
3. Approximate date land -disturbing activity will commence: 11 01 2021
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.); Residential
5. Approximate acreage of land to be disturbed or uncovered: 1.971 acac.
6. List total site acreage: �6 719 ac.
7. Landowners of Record (Use blank page to list additional owners):
Name: Hennigan Place Holdings, LLC, C/O Land Investment Resources
Address: 3440 ioringdon Way STE 205, Charlotte, NC 28277
*See page 3 for physical addresses owned
Telephone; [phone] Pax:
(Area Code) (Area Code)
Email Address: [e-mail]
Signature: WWI I
---
Name: rtan tindlay-wid-Af6ziia t=araaguno
Address: _ _-^3533 Tilley Morris Road, Matthews, NC 28105, Mailing: 4937 Providence Country Club Dr, Charlotte, NC
Gal-Soo-0
441
Telephone: Fax:
(Area Code) (urea Code)
Email Address: [e-mail]
euSf@xec{- elk,, -
Signature,
B86ki139Cdg76�6..-116P86186F884E9..
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book, 35438 page 377 i Dook_30597 page 612
Book 34935 Page 53s gook 30597 Page 615
Page l

Continue - Financial Responsibiiityl-Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this lan&disturhing activity:
Pmon or Firm: Henni an Place Holdin s LLC
Address: 3440 Toringdon Way STE 205, Charlotte, NC 28277
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: Pmhayes c(Dlandinvestmentresources.com
2. North Carolina agent, for the person or firm who is fnanci.al.ly responsible:
Person or Finn: Hennigen Place Holdings LLC
Address; 3440 Toringdon Way STE 205, Charlotte, NC 28277
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: pmhayes@landi€tvestmentresources.com
3. The above information is true and correct to the best of my Imowledge and belief and was provided by ire
while under oath. (This fonn trust 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.)
rG -
of'_"�1�
certify that o
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ritle
i+ tato
Date
a Notary Public of the County
Mate of hereby
Personally
appeared bgfore me this day and under ocafh aeknoi ledge that this form way executed by him1her.
Witness my hand and notarial seat, this day of ��20 CZ
Notary Signature:
My Commission expires,-_ cog-44f, �✓
Notary public
Mecklenburg County
North Carolina
My Commission Expires �aPa'� �H14RI�`I"ll'E�
MANAGEMENT
Laud Development Division
600 Fast Fourth Street, Charlotte North Carolina 28202-2844
Telephone:7i14/336�6692 Fax:704/33G-.6586
hitp,Iila rdpermits.chartneck.org
Pap 2

Landowners of Record:
Name: Hennigan Place Holdings LLC C/O Land Investment Resources
Address: 3537 Tilley Morris Road, Matthews, NC 28105
Parcel ID # 23111445
Mailing;1440 Toringdon Way, Ste 205, Charlotte, NC 28277
Telephone: [phone]
Email Address: Pmhayes(a)landinvestmentresources.corns
DB: 30597 PG: 615
Signature: fvv
Name: Hennigan Place Holdings, LLC
Address: 3415 Tilley Morris Road, Matthews, NC 28105
Mailing: 5615 Potter Road, Matthews, NC 28104
Telephone: [phone]
Email Address: amhayes!21andinvestmentresources.com
DB: 35606 PG: 776
Signature:

DocuSign Envelope ID: 02BE1B81-5B8D-4C3C-B65C-14EECFBE7FFE
Name: Paul Moonan and Tara Helms
Address: 3615 Tilley Morris Road, Matthews, NC 28105
Mailing: 3615 Tilley Morris Road, Matthews, NC 28105
Telephone: [phone]
Email Address: [e-mail]
DB: 36246 PG: 060
DocuSigned by:
Docu5igned by: 16/Z021
�0 �` /016/2021 1189E45D9C954A44D..
ara Helrris�
Signature: �/ /'/
--�E23GA83B8E?a•4�8...
Name: Justin and Kathryn Patel
Address: 3609 Tilley Morris Road, Matthews, NC 28105
Mailing: 200 Wintergreen Lane Boone, NC 28607
Telephone:
Email Address:
DB: 34936 PG: 536
Signatu

Name. Paul Moonan and Tara Helms
Address. 3615 Tilley Morris Road, Matthews, NC 28105
Mailing: 3615 Tilley Morris Road, Matthews, NC 29105
Telephone: [phone]
Email Address. [e-mail]
DB: 36246 PG: 060
Signature:__ —
Game: Justin and Kathryn Patel
Address: 3609 Tilley Morris Road, Matthews, NC 28105
Mailing: 200 Wintergreen Lane Boone, NC 28607
Telephone: '9 � & - 7 19 - c r, -/ -,z
Small Address: 7-1 - - I I- �je 16"1q, "'k
DB: 34936 PG: 536
Signature.,_

Name: Peachtree Residential NC, LLC
Address: 3545 Tilley Morris Road, Matthews, NC 28105
3529 Tilley Morris Road, Matthews, NC 28105
3505 Tilley Morris Road, Matthews, NC 28105
8541 Tilley Morris Road, Matthews, NC 28105
Mailing: 7380 McGinnis Ferry Road, Suwanee, GA 30024
Telephone: [phone]
Email Address: [e-mail]
DB: 35881 P�;, DB: 35681-149 PG: 149, DB: 36163 PG: 821
0
Signatu

Name: Kevin and Jennifer Kovacs
Address: 3603 Tilley Morris Road, Matthews, NC 28105
Mailing: 3603 Tilley Morris Road, Matthews, NC 28105
Telephone: [phone]
Email Address: [e-mail]
DB: 36532 PG: 787
Signature: L, a� /Y
V