NCC220655_FRO Submitted_20220207

❑URHAM
COUNTY
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Durham City/County
Sedimentation and Erosion Control
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(Office Use Only)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORK!
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: Farrington Townes
2. Road location of land -disturbing activity: Farrington Road Old Chapel Hill Road
Tax Map - Block - Parcel: PID: 140619, 140620 PIN: -6223
3. Square footage of land to be disturbed or uncovered:10.76,$ SE
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Name
1900 TorringtQn Street
Address
Rglela NC 27615
City State Zip
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.
Fuller Land & Development Jim Anderson
Name
8801 Fast Park Drive, Suite 301
Street Address
Raleigh NC 27617
City State Zip
919.417.0057
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 ■ [phone] ■ Fax [phone]
www.co.durham.ne.us/ceng

■ 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:
P7ullur [ surd Dev�l�pm�n
Name
_B foi _ F_as� Park Ur Uk Sol
SeetAddr ss
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`' State Zip q 1 SfigA& 14MJcy. W1'1'1 _
a 9 - y l �- 005 � •t�r►dcx�O n ( 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 made by the Sedimentation and Erosion Control Office.
LIA S /aox _ Soup t s F AndAt&j
Date S+ Type or PrintP%I�ipy
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Fax Title or Autho
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Business Applicant (Provide_ corporate resolution on signatory authority
I, Amw 13 - Mks. , a Notary Public of the County of Wak
State of Nov %h CLWOh A , hereby certify that Sa" F. AvLasm
personally came before me this day and acknowledged that he is _ MM W ty
of _W _10���LUand acknowledged, on behalf of 1'hktn+ur • V [L(
the due execution of the foregoing instrument.
Witness my hand and official seal, this OZ day of A W , 20
AMA;�s !0 *Aur,
A Notary Public
My commission expires AuquA t 20 Q1
LAUREN B MATAS
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WAKE COUNTY, N.C.
Individual Applicant MY Commission Exom o6-is-2ou
I,
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 them.
Witness my hand and official seal, this day of
Notary Public
My commission expires 20,
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
20

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 activilies to occur on the property listed in
Item 2 by the person or entity listed in Item 5. 1✓i,U,- &V n R)�' ( f-'W--pE�j Pvrv.n 1 L�
Telephone _ Fax _ T2tle or Authority
Email
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Business Landowner—Prowii�d�e co orate resolution on signatory authority
I,.�"11 a Notary Public of the County of
State of '>�"Y ] l 1 V/ , hereby certify that LeDn. �eavmajq
personally came before me this day and acknowledged that he is O w j1.uir—
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of I.�oukoi[X 6o&d} P&d ZZe and acknowledged, on behalf of _ �La _
O-ZM , the due execution of the foregoing
/insttrrumentt.
Witness my hand and official seal, this I day of y 11- �� I '20
Notary Public
My commission expires 20.
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Individual Landowner
I,
State of
, a Notary Public of the County of
, hereby certify that
Wake Co., North Carolina 1
My Commission Expires June 9, 2021
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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
My commission expires
day of
Notary Public
20
20
SE-03 Rev.07/06