NCC230880_FRO Submitted (2)_20230330

JCN
(Office Use Only)
Durham City/County
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM WITH LAND
OWNER 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: Cedar Trace Apartments Extension: Yes or Nu
2. Road location of land -disturbing activity: Carr Road Durham
Tax Map - Block - Parcel: 131247 131246131245 131244 131249 PIN: 0841-32-30-7129, 0841-32-50-41823 0841-
32-60-9004 0841-31-89-5925 0841-31-65-1648
3. Square footage of land to be disturbed or uncovered: 12.05 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):
Iredell Fam i lv Investments. LLC
Name
1201 Edwards Mill Road Suite 300
Address
Raleigl, NC 27607
City State Zip
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.
Cedar Trace Durham LLC
Name
631 Dickinson Avenue
Street Address
City State Zip
252-916-2691 dust inCa, taftrniIIsgr•ou p.con
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.
201 E. Main St, 511 Floor, Durham, N.C. 27701 a [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:
COW 15ALc t,l (,
Name
631 Dickinson Avenue 400
Street Address
Greenville NC: 27834
City State Zip
252-916-2691 dustinga-�tiftmills rout .cam
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.
02/16/2023 Dustin T. Mills
Date
252-916-2691
Telephone
dustin wtaftmillsL,rouP.Ctim
Email
Fax
Type or Print Name
Member/Manager
Title or Autbority
Signature
Business Applicant (Provide corporate resolution on sign#tort' authority)
I, ::Tusb,� D . W ihluM6 , a Notary Public of the County of
State of (tor-(n CAALO .cva, , hereby certify that
personally came before me this day and acknowledged that he is
of Oed d,,ryda, DA'1&--o . w,(/ and acknowledged, on behalf of
Witness my hand and official seal, this
My commission expires ol- la -
Individual Applicant
I,
State of
+Nu, LLC
the due execution of the foregoing instrument.
day of W6 20 Z3
Notary Public
20 �.
a Notary Public of the County of
hereby certify that
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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
20
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE

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.
2/17/2023
James Anthon
Date Type or Print Name
919-832-1110 OwnerlManager _
Telephone Pax I'i titllo '
[e-mail] _
Email Sig atui
13usluess l,anc3owttcr ii'1'Qt'1[IC [[1[tuH.l[i' 1-'tinit[tlorl Oil Sigila(m]' altthorily
a Notai}, Public of the County of
State of /v C hereby certify thatf]`��
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personally came before me (his day and acknowledged that he is_2
of%IL [/ ��'�tlf�tl �tukno cif Igv, on behalfof the clue execution of the foregoing instrument.g
1ViUlcss my hand and official seal, this �� Ih clay of r �} - 4 v
/� avoC3 20 My commission expires �2 Notary Public.
Individual Landowner
1,
Slate of
a Notary Public of the County of
, hereby ceitily that
personally appeared before nle this (late and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this. _ _ day of
My commission expires
2.0
Nolal), Public
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