Loading...
HomeMy WebLinkAboutNCC223198_FRO Submitted_20220912JCN (Office Use Only) bre Durham City/County Sedimentation and Erosion Control FINANCIAL RESPONSIBILITY/OWNERSHIP FORM WITH LANDOWNER CONSENT FORM No person may initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance before a Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Land Disturbing Permit does not relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State, County or Municipal governments. This office must be notified in writing of any change to the information on this form. PLEASE TYPE OR PRINT 1. Project name: Ascend Brightleaf Apartments 2. Road location of land -disturbing activity: Sanders Avenue and May Street Tax Map - Block - Parcel: 203363 Tax Map - Block - Parcel: 211393 Tax Map - Block - Parcel: 164913 Tax Map - Block - Parcel: 211392 Tax Map -Block -Parcel: 164911 Tax Map - Block - Parcel: 211388 Tax Map - Block - Parcel: 164916 Tax Map - Block - Parcel: 164914 Tax Map - Block - Parcel: 164909 Tax Map - Block - Parcel: 164918 Tax Map - Block - Parcel: 164929 PIN: 0759-19-11-6729 PIN: 0759-18-98-6527 PIN: 0759-18-69-7307 PIN: 0759-18-27-6012 PIN:0759-18-34-5405 PIN: 0759-28-37-3743 PIN: 0759-18-98-2417 PIN: 0759-18-87-2472 PIN: 0759-18-75-2468 PIN:0759-28-62-7692 PIN: 0759-28-92-3653 3. Square footage of land to be disturbed or uncovered: 981,340 square feet (22.53 acres) 4. List below the landowner of record. Each landowner must complete Item 8. (If there are multiple owners, please list on a separate page): DHIC-Brightleaf. LLC Name 1341 Horton Circle Address Arlin ton TX 76011-4310 City State Zip JaD 390-8200 Telephone Fax Email 5. List the person or entity financially responsible for this land -disturbing activity: The financially responsible party shall be (1) the developer or other person who has or holds themselves as having financial or operational control over the land - disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or indirectly allowed the land -disturbing activity or have benefited from it and (3) the named party on the Land Disturbing Permit. DHIC-1342htleaE LLC Name 1341 Horton Circle Address Arlin ton TX 76011-4310 City State Zip 817 390-8200 Telephone Fax Email 201 E. Main St, 5' Floor, Durham, N.C. 27701 • (919) 560-0735 a Fax (919) 560-0740 www.co.durham.nc.us/ceng The Sedimentation and Pollution Control Act (Act) and the Durham City -County Unified Development Ordinance (Ordinance) includes, but is not limited to, the following legal obligations of the financially responsible party: ■ Maintain a set of approved sedimentation and erosion control plans, if required, on site. ■ Display permit on site. ■ Understand and implement any required plan, including the construction sequence and details. ■ Inspect, maintain and repair sedimentation and erosion control measures, especially after rainfall events. ■ Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar days. ■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation. 6. For business applicants, list below the North Carolina registered agent for the financially responsible entity: CT Corporation System Name 160 Mine Lake Ct Suite 200 Street Address Raleigh NC 27615 City State Zip 919-944-4780 Telephone Fax Email 7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I understand that the person or entity listed on Line 5 above will be: (1) the owner of the Land Disturbing Permit when issued; (2) responsible for ensuring compliance with the Act and Ordinance; and, (3) will be the only person or entity with standing to appeal any action taken or decision made by the Sedimentation and Erosion Control Office. June 13tb, 2022 Elam Hall Date Type or Print Name 704-516-1177 Vice President Telephone Fax Title, or Aatbgrity Email Business ApRlicant Provide c❑ orate resolution on si natoiauthority) �j I, a Notary Public of the County of State of. , hereby certify that _ f �F r-._ iym, personally came before me this day and acknowledged that he is Vice- Pres'04&.V'" Of LtG and acknowledged, on behalf of. D N' IC L4 icy' L tC Witness my hand and official seal, this the due execution of the forego l Q day of My commission expires 1 20G� Individual Annlicant instrument. 202-L ublic L�HS�PES, EL✓1iNfrNotarForsy I, J. a Notary Public of the County of State of _ , hereby certify that personally appeared before me this date and under oath acknowledged that the above form was executed by them. Witness my hand and official seal, this day of My commission expires Notary Public 20 20 LAND DISTURBING PERMITS ARE NON -TRANSFERABLE Provide a Notarized Item 8 for each landowner listed in Item 4. S. Land Owner Consent. As a landowner, I provide my consent for land -disturbing activities to occur on the property listed in Item 2 by the person or entity listed in Item 5. June 13" 2022 Elam Hall Date Type or Print Name 704-516-1177 Vice President Telephone Fax Ti o Eithori REHallAdrhorton.com _ ?0 4. Email Signature Business Landowner Provide c I, resolution on signatory authority) _... a Notary Public of the County of 1 �- State of P L , hereby certify that (Z 1(u.-, /,6 /i personally came before me this day and acknowledged that he is ice pr e5''f4 4- of 1)44s Co+�,�++�,. rx. U-C and acknowledged, on behalf of _ D 14 , the due execution of the foregoing i strurnent. Witness my hand and official seal, this ! day of �. Notary My commission expires Individual Landowner I, , a Notary Public of the County of State hereby certify that 20ZZ- S. ELAINE HUDSPETH Notary Public Forsyth County personally appeared before me this date and under oath acknowledged that the above form was executed by them. Witness my hand and official seal, this My commission expires 20 day of . 120 Notary Public 5E-03 Rev.07/06