NCC224079_FRO Submitted_20221212

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: Tanoak Subdivision
2. Address of land --disturbing activity: 1065 Homestead Glen Blvd. (Lots 3, 4, 5, 22 & 23)
3. Approximate date land -disturbing activity will commence: Dec. 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential (SF Homes)
5. Approximate acreage of land to be disturbed or uncovered: 0.63 ac.
6. List total site acreage: 22.13 ac.
7. Landowners of Record (Use blank page to list additional owners):
Name (1) : Homestead Glen, LLC
Address:_ 18240 TayRoortDr_
Charlotte, NC 28278
Telephone: [phone] Fax:
N/A
(Area Code) (Area Code)
Email Address: rkieler a,cardinaldeyzrb.com (Richard Kieler)
Signature: See Authorization Letter from Owner
Name (2):
Address:
Telephone:
(Area Code)
Email Address:
Signature:
Fax: N/A
(Area Code)
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 37086 Page 206
Book Page
Book Page
Book Page
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Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity:
Person or Firm: NVR, Inc. /Ryan Homes
Address: 13924 Pro essional Center Drive Suite 100
Huntersville NC 28078
Telephone: _(704) 8 75-988 7 -Fax: NIA
(Area Code) (Area Code)
Email Address: dko lsko(a nvrine-corra Ran Kozusko
2. North Carolina agent, for the person or firm who is financially responsible:
Person or Firm: Corporation Service Comnan
Address: 2626 Glenwood Avenue, Suite 550
Ralei h NC 27608
Telephone: [phone] Fax.: NIA
(Area Code) (Area Code)
Email Address: NIA
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.)
Printed Name
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Notary Signature:
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Notary Public _
Mecklenburg Counts/
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Land Development Division
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone] Fax: [phone]SS6
http://Iaudpem3its.charmeck.org
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