NCC222838_FRO Submitted_20220810

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 or 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
l . Project where land -disturbing activity is to be undertaken: Aberdeen Ill
2. Address of land —disturbing activity: 3617 Ridge Rd, Charlotte, North Carolina 28269
3. Approximate date land -disturbing activity will commence: 01
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Approximate acreage of land to be disturbed or uncovered: 11 75 Ac
6. List total site acreage: 14.6 Ac
7. Landowners of Record (Use blank page to list additional owners):
Name: Troy Lee Jr. Arnette, WM R. Arnette, and Linda Sue Morgan
:address: 3617 Ridge Rd, Charlotte, North Carolina 28269
Telephone:
(Area Code)
Email ,address:
��ignaturc:��
Fax:
(Area Code)
Name: Troy Lee Jr. Arnette, Joann E. Aknette I_ -
Address: 3617 Ridge Rd, Charlotte, North Carolina 28269
Telephone:
Email Addi
Signature:
Is
Fax:
(=Area Code) (Area Code)
Indicate Book and Page where deed or ii(strul
instruments) Book 12848 Page 46
Book 3636 Paee 0355
01
iled (Use blank page to list additional deeds or
Book 7978 Page 504
Book Page
2023
Year
Page I

City of Charlotte
Financial Responsibility Form
Project:
Project Location:
Additional Landowners:
Name:
Address:
Signature:
Aberdeen 111
3617 Ridge Road, Charlotte, NC 28269
Linda Sue Morgan
3539 �dge Road,
i'
harlotte,, NC 28269

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Mll Homes
Address: 5350 77 Center Drive, Suite 100, Charlotte, North Carolina 28217
Telephone: [phone]
(Area Code)
Email Address: [e-mail]
Fax:
(Area Code)
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
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
ejncially responsible company or entity, if not an individual.) IdlopmM4
.S�mone 4(4e gof
Printed Name? Title
(611V " 116�i
Signatu4 Date
4 k.gc�w, Wm`Q/��� a Notaq Public of the County
of MCUMMACNState of- N o(tt 1 t, cza i l f) l/t, hereby
certify, that personally
appeared before me this day and under oath acknowledge that this form was execiaed by hint/her.
Witness nzv hand and notarial seal, this h da-V of Ott e mh. /r 20911
Notary Signature:
Nfl, Commission e_tpit-es: 01 " Q5
QLABLOTTE
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandpermits.chan-neck.org
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