NCC215293_FRO Submitted_20210927

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKECounty Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
R'rH E e My.. �N,, Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
1. Project Name Lot 2 Ester Davis & Mary Davis
2. Location of land -disturbing activity: Jurisdiction Wake Co.
Highway/Street Stony Hill Rd Latitude 35.987041
(Wake Co. or Municipality)
Longitude 78.606353
3. Approximate date land -disturbing activity will commence: August 1, 2021
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 313,453 sf
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Lawrence Homes Inc. /Jeanette Langer
Telephone [phone] Cell #
E-mail Address Lhibuilds@)yaboo.com
919-291-7897 Fax # [phone]
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Marcus & Iris Turner 919-614-1504/M 919-271-6003/1 marcus a,,mairagency.com
Name(s) Telephone Fax or E-mail address
1 1 17 Bentham Dr.
Current Mailing Address
Raleigh NC 27614
City State Zip
8. Deed Book No. 2021
Part B.
Current Street Address
City
State
Zip
Page No. 481 Provide a copy of the most current deed.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
Marcus & Iris Turner marcus(a)mairagency.com
Name E-mail Address
1 1 17 Bentham dr.
Current Mailing Address
Ralciah NC 27614 _
City State Zip
Current Street Address
City
Telephone [phone]/Marcus Fax Number
State
Zip

2. (a) If the Financially Responsible Party is not a resident of Wak>on�g�yalpr
untntify a designated agent in
Wake County to receive any notice, process, pleading in any actioceeding arising out of any
matter relating to the Wake County Erosion and Sedime Control Ordinance and/or Land
Disturbance Permit:
Name
Current Mailing Add
CO
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Na f the Financially Responsible
Party is a Corporation, give name and street address of the Regi d Agent:
Name of Registered Agent
Current Mailing Address
City
phone
-mail Address
Current Street Address
State Zip City
Fax Number
State Zip
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Marcus Turner Owner
Type or print name Title or Authority
7 27--71
Signature Date
a Notary Public of the County of
State of North Carolina, hereby certify that i' (�,r� �S Lt�nappeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this ` t��day of ,.) �1 20
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