Loading...
HomeMy WebLinkAboutNCC215293_FRO Submitted_20210927WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT No person may initiate any land -disturbing activity on one or more acres as covered by the Wake WAKECounty Unified Development Ordinance before this form and an acceptable erosion and COUNTY sedimentation control plan have been completed and approved by Wake County Department of R'rH E e My.. �N,, Environmental Services, Water Quality Division. (Please type or print and, if the question is not applicable, place NIA in the blank.) Part A. 1. Project Name Lot 2 Ester Davis & Mary Davis 2. Location of land -disturbing activity: Jurisdiction Wake Co. Highway/Street Stony Hill Rd Latitude 35.987041 (Wake Co. or Municipality) Longitude 78.606353 3. Approximate date land -disturbing activity will commence: August 1, 2021 4. Type of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 313,453 sf 6. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Lawrence Homes Inc. /Jeanette Langer Telephone 919-528-7767 Cell # E-mail Address Lhibuilds@)yaboo.com 919-291-7897 Fax # 919-882-1262 7. Landowner(s) of Record (attach accompanied page to list additional owners): Marcus & Iris Turner 919-614-1504/M 919-271-6003/1 marcus a,,mairagency.com Name(s) Telephone Fax or E-mail address 1 1 17 Bentham Dr. Current Mailing Address Raleigh NC 27614 City State Zip 8. Deed Book No. 2021 Part B. Current Street Address City State Zip Page No. 481 Provide a copy of the most current deed. 1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a comprehensive list of all responsible parties on an attached sheet. Include requested information): Marcus & Iris Turner marcus(a)mairagency.com Name E-mail Address 1 1 17 Bentham dr. Current Mailing Address Ralciah NC 27614 _ City State Zip Current Street Address City Telephone 919-614-1504/Marcus Fax Number State Zip 2. (a) If the Financially Responsible Party is not a resident of Wak>on�g�yalpr untntify a designated agent in Wake County to receive any notice, process, pleading in any actioceeding arising out of any matter relating to the Wake County Erosion and Sedime Control Ordinance and/or Land Disturbance Permit: Name Current Mailing Add CO Telephone E-mail Address Current Street Address State Zip City State Zip Fax Number (b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name, attach a copy of the Certificate of Assumed Na f the Financially Responsible Party is a Corporation, give name and street address of the Regi d Agent: Name of Registered Agent Current Mailing Address City phone -mail Address Current Street Address State Zip City Fax Number State Zip The above information is true and correct to the best of my knowledge and belief and was provided by me under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute instruments for the Financially Responsible Person). I agree to provide corrected information should there be any change in the information provided herein. Marcus Turner Owner Type or print name Title or Authority 7 27--71 Signature Date a Notary Public of the County of State of North Carolina, hereby certify that i' (�,r� �S Lt�nappeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this ` t��day of ,.) �1 20 ��It111f11111� Sa1d �� �••.�.. � �i�� ;� otary •cc` e•• SA&� ' My commission expires �G to: