NCC242899_FRO Submitted_20240919

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
13E0 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
"` WITH LANDOWNER CONSENT FORM
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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: Tesch Extension: Yes or No
2. Road location of land-disturbing activity:2401 Fletchers Chapel Road
Tax Map-Block-Parcel: 170565 pIN:0852667200
3. Square footage of land to be disturbed or uncovered:72,875 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):
Michael Tesch
Name
9903 Remedios Walk
Address
Raleigh NC 27617
City State Zip
[phone] [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.
Jason Radford-Radford Building Company
Name
127-C Wolfpack Drive
Street Address 27704
Durham NC
City State Zip
[phone] [e-mail]
Telephone Fax Email
JR As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
(Initials) communication at JASON©RADFORDBUILDINGCOMPANY.COM
(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,56 Floor,Durham,N.C.27701 •[phone]•Fax[phone]
www.co.durham.nc.us/ccng

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Jason Radford-Radford Building Company
Name
127-C Wotfpack Drive
Street Address
Durham NC
City 27704
[phone] State Zip
Telephone [e-mail]
Fax Email
7. The above information is true and con-ect 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: (I)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 Sediments-ion and Erosion Control Office.
Date
Jason Radford
[phone] hype or Print Name
Telephone Business Owner-Co actor
Fax [e-mail] Title or Thor
Email
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Business A 'leant(Provide corporate resolution on signatory authority)
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Individual A nlicant
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.