NCC217182_FRO Submitted_20220103

DURHAM
COUNTY
1EQ
last
Durham City/County
Sedimentation and Erosion Control
JCN
(Office 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 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: Tanglewood
2. Road location of land -disturbing activity: 3016 Page Road
Tax Map - Block - Parcel: PIN: 0758-35-15-6278, 0758-45-04-3911
3. Square footage of land to be disturbed or uncovered: 1,043,698 s.f. - 23.96 AC
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Lennar Carolinas, LLC
Name
1100 Perimeter Park Dr. Suite 112
Address
Morrisville NC 27560
City State Zip
919-465-5935 [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.
Lennar Carolinas, LLC
Name
1100 Perimeter Park Dr. Suite 112
Street Address
Morrisville NC 27560
City State Zip
919-465-5935 [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 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.
■ Refer to Section 12.10.413 of the Durham City/County UDO for groundcover time line requirements.
■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
120 E. Parrish Street, Law Bldg., I" Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.deone.gov/i ndex.aspx? page=180

6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
Troy George
Name
1100 Perimeter Park Dr. Suite 112
Street Address
Morrisville NC
27560
City State
Zip
919-465-5935
Telephone
[e-mail]
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
Ia 1 1
Date
919-465-5935
... tjlwlly' Fax
[e-mail]
Troy George
Type or Print Name
Divisioo,President
a Notary Public of the County of Wak
State of _ �GV ( (a 6144 hereby certify that .e
personally came before me this day and acknowledged that he isD 1/I
of _e_P Ka rCak_ i S UL and acknowledged, on behalf of ve- h a C LLC_
the due execution of the foregoing instrument.
Witness my hand and official seal, this day of 20 �I
�� Ndtary Public //_���,'
My commission expires 20 �� �T
Individual Applicant`��Cr'��
I NOTARY
a Notary Public of the County of
State ofLIC
hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by th e CO,I; ,N �i,` 1
Witness my hand and official seal, this day of
,20
Notary Public
My commission expires 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 5.
( Troy George
Date Type or Print Name
919-465-5935 Division President
Telephone
ennar.com
Email
Fax
Authority
i Yee, 'C ii , a Notary Public of the County of
State of hereby certify that -e-
personally came before me this day and acknowledged that he is _ Div i $l`IJYf Pl Les Aa t�
of WK I -AV- (O'd iK I [ and acknowledged, on behalf of Le K Ka r 64 "t %Y(Le' i
, the due execution of the foregoing instrument.
Witness my hand and official seal, this day of 20
guqulurn
fr``"rnu�
l�� Nota �l'ublic s�`.�.••. oy��O'o�
My commission expires "C`— 177 26vt�.r ��
NOTARY�r'
Individual Landowners •,. �e'
I> a Notary Public of the County of �,�'��COv•»T' , G`�r.�`
Y .;,•:
hri rn�n
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 120
Notary Public
My commission expires 20
5E-03 Rev. 10113