NCC215674_FRO Submitted_20211013

Durham City/County
Sedimentation and Erosion Control
9190
(Office Use Only)
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: Lochwood Olive Branch East
2. Road location of land -disturbing activity: 551 Olive Branch Road. Durham NC
27560
Tax Map - BIock - Parcel
193433
3. Square footage of land to be disturbed or uncovered:
PIN: 0860-45-97-5737
19.0 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):
Shaw Hill 221nvestors
Name
1919 White Plains Road
Address
Chapel Hill, NC 27514
City State Zip
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.
Lennar Carolinas LLC
Name
1100 Perimeter Park Drive, Suite
Street Address
Morrisville NC 27560
City State Zip
(919)465-
5900 troy.george(afflennar.com
Telephone Fax Email
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.
201 E. Main St, 5"' Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.co.durham.ne.us/ceng

• 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:
Troy George
Name
1100 Perimeter Park Drive Suite 112
Street Address
Morrisville NC
City state
919-465-5935
Telephone
Fax
27560
zip
[e-mail]
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.
71rsl u
Date
919 465-5900
Telephone Fax
troy.george(i�lennar.com
Email
Type or Print Name
Title
Business Applicant (Provide corporate resolution on sianatory authori
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State of aJCV-'k CaO-0 +1 "L , hereby certify that C-1-e6r -Q
personally came before me this day and acknowledged that he is 1 S i CV"
of L-P—&tW4V Ctt✓'y1 r►kCV% t I r and acknowledged, on behalf of L-0�_'K" r62P-()Lllt (�LL
Witness my hand and official seal, this
the due execution of the foregoing instrument.
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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 _ 20
Notary Public

Provide a Notarized Item 8 for eacli landowner listed in Item 4.
8. 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.
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Business Landowner (Provide corporate resolution on sianatory authorit
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personally came before me this day and acknowledged that he is
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the due execution of the foregoing instrument.
Witness my hand and official seal, this 011, dt of .� 20 a1/
Notary I rblic
My commission expires it - c-20 - a26-2-1 20 Notary Public
Durham County, NC
Individual Landowner
I,
State of
, a Notary Public of the County 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
My commission expires
day of
Notary Public
20
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