NCC222681_FRO Submitted_20220727

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: RIDGE RD SELF -STORAGE
2. Address of land ---disturbing activity: 2601 RIDGE RD. CHARLOTTE, NC 28269
3. Approximate date land -disturbing activity will commence: AUGUST 1 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): COMMERCIAL
S. Total acreage of land to be disturbed or uncovered: 3.15 ACRES
6. List total site acreage:3.55 ACRES
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: AREP RIDGE, LLC
Address: 2620 SELWYN AVE. STE. 618
CHARLOTTE, NC 28209
Telephone; 704 910-7103 Fax:
(Area Code) (Area Code)
Email Address: JOSHUA@a APPALOOSAREP.COM
Name:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 14021 Page 85 Book Page
Book Page Book Page
Page I

Continue Financial Responsibility/Ownership Form
PART B
l . Person(s) or firm(s) Financially responsible for this land -disturbing activity (Note: If the f anciolly responsible
person(s) or firni(s) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: AREP RIDGE, LLC
Address: 2620 SELWYN AVE. STE. 618
CHARLOTTE NC 28209
Telephone: [phone] Fax.
(Area Code)
Email Address: JOSH
PPALOOSAREP.COM (Area Code)
2. if the .Financially Responsible Patty is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm:
Address:
Telephone:,
(Area Code)
Email Address:
ax:
(Area Code)
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.)
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Printed Name
uC4
Signature
I,
Title
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Daiie
a Notary Public of the County
of 1 enb Prq ,State of 01A ? hereb
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certify chat ac- tive
ersonally
appeared before me this day and under oath acknowledge that this foam was executed by hina/her.
Witness my hand and ngtaria1,vea1,11?is zZnd day of ' U
Notary Signature:
My Commission expires: Agylolktr
2022-
STACII: LEAVITT
Notary Public, North Carolina
Iredeli County
My Commission Expires
November0l, 2025
chalrlottenc.gov
Storm Water Services -- band Development
600 Fast Fourth street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
htt :/Icllat-lotteiic. ov/develo ❑ientcenter
Rev. OR/Z021 Page 2