NCC223900_FRO Submitted_20221121

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 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: Prose NoDa
2. Address of land —disturbing activity: 2600 N Tryon St, Charlotte, NC 28206
Approximate date land -disturbing activity will commence:
Month Day
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Commercial
Approximate acreage of land to be disturbed or uncovered: 3.48 AC
6. List total site acreage: 3.50 AC
7. Landowners of Record (Use blank page to list additional owners):
Name: Try Math Investors LLC
Address: 338 S Sharon Amity Road, PMB Unit 510
Charlotte, NC 28211
Telephone: — ?» r a / Fax:
(Area Code) (Area Code)
Email Address: rci (�% �% CeCOM(ye
Signah
Name:
Address:
Telephone: Fax:
(Area Code)
Email Address:
Signature:
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 36788 Page 985-991 Book Page
Book Page Book Page
Year
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
i . Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: Alliance Realty Partners, LLC
Address: 200 Providence Road, Suite 250
Charlotte, NC 28207
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:
Address:
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
I 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.) P
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Printed Arne A . Title
-q- 1 21� 2 7-2
Date
1, sj'iV1 L - 0 YI.0 te'( a Notary Public of the County
Of State of [� UVa'�/1 lrl1� i/iin�1 hereby
certify that 01M V 101W personally
appeared before me this day and render oath acknowledge that this form Bras executed by him/leer.
Witness my hand anal nPtarial seal, 1h day of _� 20r
Notary Signature:
My Commission e
KRISTIN L. VINESETT
Notary Public. North Carolina
Mecklenburg County
- My Conn 's i n x i es
01ARLOM_
ENGINEERING 8 PROPIM
MANMEMENY
Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone;704/336-6692 Fax:[phone]
htlp:/Aandpemtits.charmeck.orb
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