NCC216333_FRO Submitted_20211115

Durham City/County
Sedimentation and Erosion. Control
JCN
(Orticc Use Only)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
No person may initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance before a
Land Disturbing I'ern-it is issued by the Sedimentation and Cfosion 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
]. Project name: Cree- B10 CG Expansion Stockpile
2. Road location of land -disturbing activity: 4300 Silicon Drive
Tax Map - Block - Pat -eel:
NIA
PIN: 0748-04-74-6061
3. Square footage of land to be disturbed or uncovered: 43,560 SF (1 Acre)
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Cree, Inc Accts Payble Dept
Name
PO Box 110005
Address
Durham NC 27709
City State Zip
919-407-5111 [e-mail]
Telephone Fax Email
5. List (lie person or entity financially responsible for tbis land -disturbing activity: The financially responsible party shall
be (1) the developer or other person who has or holds themselves as leaving 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 laud -disturbing activity or have benefited from 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 [e-mail]
Telephone Fax Email
The Sedimentation and Pollution Control Act (Act) and the Durham City -County Unified Development Ordinance (Ordinance)
includes, but is not linvted 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, inaintain 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`i' floor, Durham, N.C. 27701 • [phone] • Fax [phone]
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■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
6. For business al)plicants, 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 [e-mail]
Telephone Fax Email
7. The above inform -ration is true and correct to the best of my knowledge and belief and was provided by me while under oath, 1
understand that the person or entity listed on Line S above will be: (1) the owner of the Land Disttn•bing 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 takcn or decision made by the Sedimentation and Erosion Control Office.
10/r;//zl Chris McCann
Date Type or PrjaV4anic
919-407-5111 Dire t Global Project Management
Telephone Fax jT;W"'thority
cmccann@)cree.com
Email
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Business Applicant(Provide corporate resolution on signatory authority)
n 0 115 a Notary Public of the County of /� _
State of _ f�p��- Cam 1:�� , hereby certify that C C_ Mn in
personally came before me this day and acknowledged that Ire is �Prd, e cf- A-4 .
of e— C_. _ and acknowledged, on behalf of Ce e .0
the due execution of the foregoing instrument,
Witness my hand and official seal, this I sp,— day of l✓ , 20
Notary Public +•'�
My commission expires NO O , 20�� r.Q
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Individual Applicant • , '
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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
My commission expires
20
Notary Public
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE

Provide a Notarized Item S 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 Rem S.
R) Its Iz I Chris McCann
Date Type or Pry NaW
919-407-5111 Directort�al P_r_ojecl Management
Telephone Fax )we�
cmccann(@cree.com
Email
Business Landowner (Provide corporate resolution on signatory autlioi'it /-�,,
I, ] , 6;;r l n (LS a Notary Public of the County of _yf=_aaa P
State of ]V , hereby certify that L' L G[.li n ,,11
personally came before me this day and acknowledged that be is rP_[.-!p r
of �Q,P �.t ] C - and acknowledged, on behalf of L
the due execution of the foregoing instrument.
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Witness my hand and official seal, this--.— �--- day of 0 (T�n jj�� #tip• O
Notary Public
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My commission expires � d � � � , 20UBLIC__,Zi._� e `A�'•. � V
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Individual Landowner
1, , a Notary Public of the County of
State of
hereby certify that
personally appeared before nic this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this . _ . day of
Notary Public
My conniiission expires 20
20
SB-03 Rev.07/06