NCC230641_FRO Submitted_20230310

City of Charlotte Soil Erosion and
Sedimentation
Control Ordinance
Financial Responsibility/Ownership Form
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: Hamilton Street Townhomes
2. Address of land —disturbing activity: Hamilton Street, Charlotte, NO 28206 (PID: 07845301)
3. Approximate date land -disturbing activity will commence: 04
2023
Month Day Year
4. Purpose of Development (Residential, Commercial, Industrial, etc.): Residential
5. Total acreage of land to be disturbed or uncovered: 5
b
List total site acreage: 696
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:
Brookfield Holdings (Hamilton) LLC
Address: 250 Vesey St 15th Floor
New York, NY 10281
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: [e-mail]
Name:
Andrew Brausa
Address: 250 Vesey Street, 15th Floor, New York, New York 10281
Telephone: Fax:
(Area Code) (Area Code)
Email Address:
8. Indicate Book and Page where deed or instrument is filed (Use blank page to list additional deeds or
instruments) Book 30796 Page 156 Book Page
Book Page Book Page
€'age €

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
per•son(s) or firm(,) has an out-of-state address, a North Carolina agent must be designated in item 2 below):
Person or Firm: Toll Southeast LP Company, Inc
Address: 9130 Kings Parage Blvd
Charlotte, NC 28273
Telephone: [phone] Fax:
(Area Code) (Area Code)
Email Address: mdenk tollbrothers.corn
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
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.)
Jaime Pou Division President
Printed
Title
I-.24-2�-
Date
I� �1 Lf� A'PP P�ZLV� T[G a Notary Public of the County
of Stateof KOU IA CALM ln1A hereby
certify thatpersonally
appeared before me this day and under oath aclaaowledge that this form yvas executed by him/her.
Witness my hand ar
Notary Signature:
My Commission exj
AALYN LAPP PRIVETTE
Notary Public, North Carolina
Davidson County
My commission Expires
May 26, 2025 JI
SM
charlottenc.gov
Stonu Water Services — Land Development
600 East Fourth Street, Charlotte, North Carolina 28202-2844
Telephone: [phone]
/ hart ttnc. ov de elo nienteenter
Rev. 09t2021
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