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HomeMy WebLinkAboutNCC222901_FRO Submitted_20220812City 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 1. Project where land -disturbing activity is to be undertaken: 5unbriar subdivision (AKA Sunbriar Drive) 2. Address of land —disturbing activity: Miranda Road Charlotte (Mecklenburg), NC Approximate date land -disturbing activity will commence: August 15 2©22 Month Day Year 4. Purpose of Development (Residential, Commercial, Industrial, etc.). Residential 5. Approximate acreage of land to be disturbed or uncovered: ±6.9 AC. 6. List total site acreage: ±7.68 AC. 7. Landowners of Record (Use blank page to list additional owners): Name: Pulte Home Company LLC Address: 11121 Carmel Commons Blvd Charlotte, NC 28226 Telephone: Fax: (Area Code) (Area Code) Email Address: Signature: Name: Address: Telephone: Fax: (Area Code) Email Address: Signature: (Area Code) 8. Indicate Book and Page where deed or instrument is Piled (Use blank page to list additional deeds or instruments) Book 37538 Page Book Page 221 Book Page Book Page Page I Continue - Financial Responsibility/Ownership Form PART B 1. Person(s) or firm(s) financially responsible for this land -disturbing activity: Person or Firm: Pulte Home Company, LLC Address: 11121 Carmel Commons Blvd, Suite 450 Charlotte, NC 28226 Telephone: (704) 543-4922 Fax: (Area Code) (Area Code) Email Address: leremy.huntsman@pultegroup.com 2. North Carolina agent, for the person or firrn who is financially responsible: Person or Firm: NIA Address: Telephone: Fax: (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 company or entity, if not an individual.) Jeremy Huntsman Printed Name Signature 1, Director of Land Development Title Date a Notary Public of the County State of t4 hereby certify that ��e mv� 1,�k5wn 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 V'1\A0\jA Sk 20 ZZ Notary Signature: My Commission expires: \yii111111oi `� �CA.•�fiissip,�•h�i. ��r @ . N� '.'Ki r3_2a? A- aiaw.orrE_ ENGINEERING & PROPERTY MANAGEMENT Land Development Division 600 East Fourth Street, Charlotte, North Carolina 28202-2844 Telephone:7041336-6692 Fax:704/336-6586 http://Iandpermits.charnieck.org Page 2