HomeMy WebLinkAboutNCC216334_FRO Submitted_20211115JCN
�G
Wiliam City/County
Sedimentation and L, rosion Control
(office Use Only)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
No person nlay initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance beforea.
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office, Issuance of a Land Disturbing Permit does not
relieve the perniittee 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:_ Cree - B10 CG Expansion
2. Itoad location of land -disturbing activity: 4425 Silicon Drive
Tax Map - Block - Parcel: N/A
PIN: 0748-04-72-5117
3. Square footage of land to be disturbed or uncovered: 130,680 SF (3 Acres)
4. List below the landowner of record. Each landowner must complete Item S.
(If there are multiple owners, please list on a separate page):
Cree, Inc Accts Pa bie Dept
Name
PO Box 110005
Address
Durham NC 27709
City State Zip
919-407-5111 cmccann@cree.com
Telephone
Fax
Lnrail
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 frorn it and (3) the named party on the Land Disturbing Permit,
Cree, Inc
Name.
4600 Silicon Drive
Street Address
Durham NC 27703
City State - Zip
919-407-5111 cmccann@cree.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, 5"' Floor, Durham, N.C. 27701 • (919) 560-0735 . Fax (919) 560-0740
www.co.dua-liaw.ite.us/eeng
■ 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:
Chris McCann, Director of Global Project Management
Name
4600 Silicon Drive
Street Address
Durham NC 27703
City State Zip
919-407-5111 cmccann9cree.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 niadc by the Sedimentation and Erosion Control Office.
to/IJ,
Chris McCann
Date ' Type or Print Name
919-407-5111 Direc r f obal Project Management
Telephone Fax A
rity
cmccann cree.com
Email 12nature
Business Applicant (Provide corporate resolution on si natoix authority
1, • f, P - • lb 0,1 a Notary Public of the County of _ Ora_n Q - t.
State of i JQC±h r Q _rD) ewe.., hereby certify that r • _pAC tnq'
personally came before me this day and acknowledged that he is Q {-1 C pro'. Ct
of t.rl and acknowledged, on behalf of _�Q� C .f
the due execution of the foregoing instrument. ,\��,•�Ne P-,,,�����
%
Witness my hand and official seal, this _ r✓J day of 0 , 20 Z O
Notary Public
My commission expires �t0 — t/ , 20 Z� :�2'•, g�IC
Individual Applicant
I, , a Notary Public of [lie County of
State of , hereby certify that
personally appeared before me this date and under oath acknowledged that the above form Nvas 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
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 S.
Chris McCann
Date Type or Pri Ztiie
919-407-5111 Dir o fbai Project Management
Telephone Fax t rity
cmccann@cree.com
Email
ignature
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Business Landowner (Provide corporate resolution on signatory authority)
1, P• 1 , a Notary Public of the County of
State of -Lh2(I%p I l�7�c—, hereby certify that _ ds--
personally came before me this day and acknowledged that he is. -Dire G' Dr 04- C) 10 ,b aj Pr(Q k P_ C NO—T.
of :Lrl r- and acknowledged, on behalf of C
the due execution of the foregoing instrument. tt"'""
Witness my hand and official seal, this day of___.._,_,Q , �� �L• ��������'•21�;
•= orq
lO Notary Public = •:
My commission expires 20 C1C •
Individual Landowner
m
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 there.
Witness my hand and official seal, this
My commission expires
20
day of
Notary Public
20
SE-03 Rev.07106