NCC222369_FRO Submitted_20220705

Durham City/County
Sedimentation and Erosion Control
JCN
(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:_ Woodlands 3 Mass Grading
2. Road location of land -disturbing activity: 2102 SoHi Drive
Tax Map - Block - Parcel:
PIN: 0739-66-88-5293
3. Square footage of land to be disturbed or uncovered: 610,000 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):
ARE -NC Region No 22 Holding LLC
Name
PO Box 847
Address
Carlsbad CA 92018
City State Zip
919-313-6645 Osherrill(a�are.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.
ARE -NC Region No 22 Holding LLC
Name
PO Box 847
Address
Carlsbad CA
92018
City State
Zip
919-313-6645
Osherrill(a�are.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, 5t' 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:
u-NC Rf4k)n No. 22. L
Name "
% %OD( �41
Street Address
carksbaci CA
6(201 Q�
City State
Zip
alR • 313-6045
OSherriki @ 0 • COrrl
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 Pen -nit 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.
mye- ibet, k"1.2oy Oliver 5be,rri 1 i
Date Type or Print Name
Business Applicant (Provide corporate resolution on signatory authority)
I, Cz:)abYino, N �Unk�nS , allotary Public of the County of__`Dw'ham
State of NoY+n Carolina , hereby certify that Qkiyef Sherri d
personally came before me this day and acknowledged that he is SVP — 1�•eQior-6 k Narke A- -'i 'IreCWVjIlfii/t�®
✓0' f®ao
ofK6-NC keGion NO. 22 , PLC, and acknowledged, on behalf of N X ndria Q i
1 o
/ o
(EF74 u 1tes . I tic. the due execution of the foregoing instrument.
Witness my hand and official seal, this 1-7 day of N6yyM be,- 21; i0f,
0`26-26
Notary Public ;0if'C®uv
My cormnission expires �QnG aru 2(0 _'20 2 (o 1'��t`®
*'x.:k:k#�tr.#�%R:K*�k����k �h*.k#�*#�##*#*#*#�#eY•*�#:P�#*�k#*#*��k#�##��k#####.k#*#*##&*#%k4�t �tR.k �k��#�k#fi###��*#�#�k�*:Y.*#:i:�#�k�#�#�*#**##*:g#:F#%k �k*�%K���
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 day of
My commission expires
20
Notary Public
20
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE

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.
Noyehibe,r \i ,IL2,\ Oliv., Sbenri 11
Date Type or Print Name
alq313• WAS SVP• 17e61ohal Mork-+- ^Directbv-
Telephone Fax Title or Arikhority e
Q15,he_rvl({ 0)Gtre- Corn
Email Signature
Business Landowner (Provide corporate resolution on si natog authority
1, Sekbrfha N 3UV)VihS , a Notary Public of the County of 1UVV-\O -1
State of Nhr�h Coro k vr0. , hereby certify that 04ye-r Shery i l l
personally came before me this day and acknowledged that he is �SVP - (zQQ►'tYtQl �i{Grkel" �} jrecvm�eio�111 �c®�®,
*� 1 a, .4
of A'?G -NC (24q i on No. 22., L LC. and acknowledged, on behalf of AltMneitie, kea l R
Inc. the due execution of the foregoing instrument. J� %XOX� .
�
®® �a (n _=
Witness my hand and official seal, this day of 2()B
M commission expires ` ` Notary Public ®r+�®®®coul'1a1®��$®
Y p yai'u 2io , 20 2l0
Individual Landowner
I,
State
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
9C
5E-03 Rev.07106