NCC223006_FRO Submitted_20220831

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: GESCO ST APARTMENTS
2. Address of land —disturbing activity: 718 Gesco Street, Charlotte, NC
3. Approximate date land -disturbing activity will commence: JUIV 01 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): RESIDENTIAL
5. Approximate acreage of land to be disturbed or uncovered: 3 AC
6. List total site acreage: 3.34 AC
7. Landowners of Record (Use blank page to list additional owners):
Name: CYPRESS ENTERPRISES LLC
Telephone: [phone] Fax: _70�-4S/- 093
(Area Code) L P (Area Code)
Email Address—/ K u, r e. E koe_c be r+ F na_n 0- 14
Signature":
Name: AGT&U -92t/TUCKASEEGEE ROAD OWNER LLC,
�� � malummi Am U7.1% 1=1 -
Telephone: [phone]
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 17940 Page 343
Book 36359 Page 408
Book 34114 Page 313
Book— Page
Page I

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 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 parry 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: GESCO ST APARTMENTS
2. Address of land —disturbing activity: 718 Gesco Street, Charlotte, NC
3. Approximate date land -disturbing activity will commence: July 01 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): RESIDENTIAL
5. Approximate acreage of land to be disturbed or uncovered: 3 AC
6. List total site acreage: 3.34 AC
7. Landowners of Record (Use blank page to list additional owners):
Name: CYPRESS ENTERPRISES LLC
Address: 8021 KITRIDGE BAY LN, TEGA CAY, SC 29708
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address:
Signature:
Name: AG-T&U 926 TUCKASEEGEE ROAD OWNER LLC,
Address: 1831 PEACHTREE RD STE A, ATLANTA, GA 30309
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Addre'ft.hdtarban.com
Signature:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 17940 Page 343 Book 34114 Page 313
Book 36359 Page 408 Book Page
Page I

7. Landowners of Record (Use blank page to list additional owners):
Name: AG-T&U 700 TUCKASEEGEE ROAD OWNER LLC,
Address: 1831 PEACHTREE RD STE A, ATLANTA, GA 30309
Telephone: 404,312.4743 Fax:
(Area Code)
Email
Signat,
Name:
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax:
(Area Code)
(Area Code)
Page I

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or fin-n(s) financially responsible for this land -disturbing activity:
Person or Firm: RRPVI GESCO CHARLOTTE LP
Address: 2100 S TRYON STREET SUITE 203, CHARLOTTE NC 28203
Telephone :[phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: RAM REALTY ADVISORS LLC
Address: 2100 S TRYON STREET, SUITE 203 CHARLOTTE NC 28203
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: gaugustineCcyram real estate. 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.)
DAVID KLEPSER
Printed Name _.L)
Signature
VICE PRESIDENT
Title
Date
A kVCLT T- / a Notary Public of the County
of (') NJ l 0 pl i State of /Vb F_TH C_A icy 1- ! %�,A hereby
certify that 1 A V I. TJ IL, 'E—:= f- 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 _ I day of 4 L)(7i-US T 20 -�'
Notary Signature:
My Commission expires: V� 7 C>
ELIZABETH J FAWCETT
Notary Public, North Carolina
iis' Union County
My Commission Expires
October 20, 2424
ENGINEERING & PROPERTY
MANAGEMENT
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]
http://Iandperrnits.charmeck.org
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