NCC242842_FRO Submitted_20240917

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
O WITH LANDOWNER CONSENT FORM
�1881
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: Junction and Ferrell Building 1 Extension: Yes or No
2. Road location of land-disturbing activity: Northern Durham Parkway, Junction Road and Ferrell Road
Tax Map-Block-Parcel: 236862 pm 0842759387
3. Square footage of land to be disturbed or uncovered: 1,508,614 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):
Scannell Properties#736, LLC
Name
8801 River Crossing Blvd., Suite 300
Address
Indianapolis Indiana 46240
City State Zip
908-655-5632 317-842-5957 [e-mail]
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.
Scannell Properties#736, LLC
Name
8801 River Crossing Blvd., Suite 300
Street Address
Indianapolis Indiana 46240
City State Zip
908-655-5632 317-842-5957 [e-mail]
Telephone Fax Email
x As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
(Initials) communication at [e-mail]
(Email Address)
I agree to provide any updated email addresses as necessary to ensure consistent communication is maintained between myself
and Durham County Sedimentation and Erosion Control.
Electronic notifications may include Plans Review Comments,Approvals,Disapprovals,and/or enforcement actions including
Notices of Violation,Stop-Work Orders,and/or Civil Penalties.
201 E.Main St,5th Floor,Durham,N.C.27701•[phone]•Fax[phone]
www.co.durham.oc.uskeng

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Cogency Global Inc.
Name
2810 Coliseum Centre Drive,Suite 120
Street Address
_Charlotte NC 28217
City State Zip
_866-775-0114 kbeckncr(a%cogcncyglobal.com
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.
7/110/. /! arC p�
Date Type o Print ml me
3/7-WY-59Sy �acs-
Telephone Fax Title or Auth. 'y ' r---
Emai Signature
Business Applicant(Provide corporate resolution on signatory authority)
I,6 7R 'ieS9/j ,a Notary Public of the County of,4 .9 O/1
State of -27a :0-dVGZ ,hereby certify that 777are d0" 1,+
�
personally came before me this day and acknowledged that he is t."1"'
of CG c4/e/� er- e.LC" and acknowledged,on behalf of 47,a;lGcl7.eit -
(7O/ .7 ,the due execution of the foregoing instrument.
Witness my hand and official seal,this 7�`'4( day of,/ . 20 2K
/ ,� 1 R Jack$Qn
I► • r''Ubli ,o���y�L4,+ ublVc.State of Indiana
My commission expires 2 ,20 Z +` Y ° r+amiaon County
�G!KI[-//GTtr 3 � �:i� SEAL • �mtsabn Number 891848
k ,, ,► ^M My Commission Expires
1 "+.,; , November 23.2024
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 ,20
Notary Public
My commission expires 20
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.
Date Type r rint N e c�
c3/7-8c9-5-f59 /a/lat c�
Telephone Fax Title or a
/rlarr c RFae/2/re* cam. C7on, •L
Email I Signature
Business Landowner(Provide corporate resolution on signatory authority)
I, a(�/,e cke,4.s0r1 ,a Notary Public of the County of /14 /� f
State of-Z 2 ' ,hereby certify that .�� Gaf/e ?ay,
personally came before me this day and acknowledged that he is /%1_F�%j4- 7-
cJ /
of�cfiy0,W/4* - Z7 and acknowledged,on behalf of / �� cT
9412
C'an,Arof/ ,the due execution of the foregoing instrument.
Witness my hand and official seal,this /9. - day of l/l/ 7 .201/
Publ *Y
Mycommission expires 3 � ,su►.or Indiana
r HMl�fon Ci0(Inty
P ✓� 12 20 , sE�u, commission Number 691A48
.Mv. Commission Expires
r 3.2024
Individual Landowner
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 ,20
Notary Public
My commission expires 20
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.
• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
SE-03 Rev.07/06