NCC220706_FRO Submitted_20220210

JCN
Durham City/County (once use only)
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: Sweetbrier Phase 1
2. Road location of land -disturbing activity: 1001 Olive Branch Road, Durham, NC
Tax Map - Block - Parcel: 193368 PIN:_0860-02-52-5166
3. Square footage of land to be disturbed or uncovered: 4,251,456 sf
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Clavton Properties GrouD. Inc.
Name
2521 Schieffelin Rd, Suite 116
Address
Apex NC 27502
City State Zip
919-303-8525 bclark(a�mun2o.com
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.
Clavton Properties GrouD. Inc.
Name
2521 Schieffelin Rd, Suite 116
Address
Apex NC 27502
City State Zip
919-303-8525 bclark(a�mun2o.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.
■ 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.
201 E. Main St, 5th Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.co.durham.nc.us/ceng

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:
Moore & Alphin
Name
3733 National Drive, Suite 100
Street Address
Raleigh NC 27612
City State Zip
919-787-8812 [e-mail]
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.
j Adam Speiran
Date Type or Print Name
919-303-8525 Assistant Secretary
Telephone Fax �' Title or Authority
[e-mail] [-
Email Signature
###################################################################################################################################
Business Applicant (Provide corporate resolution on siEnatory authori
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State of �64b (Aa f l hereby certify that ACIO-M 60e i V-a rl
personally came before me this day and acknowledged that he is �AGg'- i —,4tLr)t &,cmi-a r"
Of (� `Q(rl IDS C_ItDU�1 and acknowledged, on behalf of�L�?[�
the due execution of the foregoing instrument.
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ICiDARK
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Notary Public
My commission expires 20 a y
Individual Applicant
I,
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
My commission expires 20
day of 20
Notary Public

Provide a Notarized Item 8 for each 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.
Adam Speiran
Date Type or Print Name
919.686.5351 Assistant Secretary
Telephone Fax _Title or Authority
Email Signature
Business Landowner (Provide corporate resolution on signatory authority)
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State of dU&—�h ('&JJ > I f (16�_ hereby certify that jii �tk" C VZt f—)
personally came before me this day and acknowledged that he is �.� f SfAA �}�i
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the due execution of the foregoing instrument.
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A Yh da ofLtst 20 t. S day
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county
My Commission Expires
Notary Public
y commission expires 2091
Individual Landowner
1, , 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
My commission expires 20
day of 120
Notary Public
5E-03 Rev.07106