NCC230453_FRO Submitted_20230216

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Forin
No person shall initiate any land -disturbing activity on one or more acres as covered by Chapter 17 of the Charlotte
City Code of Ordinances before this form and an acceptable erosion and sedimentation control plan have been completed
and approved by the City of Charlotte. The financially responsible 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. All relevant
items on this form must be filled out accurately and completely
Please Type or Print
PART A
1. Project name: Wabash
2. Address of land —disturbing activity: 0 Wabash Ave.
3. Approximate date land -disturbing activity will commence: June 24 2022
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Total acreage of land to be disturbed or uncovered. 2.71 Ac.
6. List total site acreage: 3.037 Ac.
7. Landowners of Record (attach accompanied page to list additional owners). If the landowner of record is not
the person(s) or firm(s) financially responsible as listed in Part B, item 1, a separate letter of consent signed
by the landowner of record or their authorized agent is required:
Name: Donna M. Simpson, Mingus Legacy Trust
Address: 2514 Little Cove Rd. Charlotte, NC 28270
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
Address:
Telephone:
(Area Code)
Email Address:
Fax:
(Area Code)
Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 27373 page 266 Book Page
Book Page Book Page
Page 1

Continue - Financial Responsibility/Ownership Form
PART B
1. Person(s) or firm(s) financially responsible for this land -disturbing activity (Note: If the financially responsible
person(s) or firms) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: J. P. Development Group, LLC.
Address: 4301 Fairview Oaks Drive, Charlotte NC 28211
Telephone: [phone] Fax:
(Area Code)
Email Address: [e-mail]
(Area Code)
2. If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent:
Person or Firm: NA
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
financially responsible company or entity, if not an individual.)
Thomas Pearson
Printed
Manager
Title
Date
I, 3b .Z ll C �"' � `�� 5n a Notary Public of the County
Of /CK4JMs State of hereby
certify that Tpti V^A S / e'+9/w 1 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 M day of /20 2 ?-
Notary Signature. ._� '� e—, i'tn I
My Commission
JOSEPH E. WHALEY, JR.
NOTARY PUBLIC
Iroclell County, North Carolina
charlottenc.gov
Storm Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
Rev. 0912021 http://charlottenc. jzov/deve lopmentcenter
4;JoN `kur - -1
need MV
'1VHM or
Page 2

To whom it may concern:
City of Charlotte Soil & Sedimentation
Re Financial responsibility I Ownership Farm
Wabash Avenue parcel numbers 6310105 & 6310217
I am the owner of record on the above referenced property, and I herein consent to
designate JP Development, LLC to be the financially responsible party as they begin the
permitting & development process for these parcels.
It is expected that JP Development, LLC will become the owner of record within
approximately 30 days.
_.dnt4c Ct22-
Donna Mingus Si p n date
for Mingus Legacy Trust