NCC230405_FRO Submitted_20230214

lw�w WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
P=1 SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKE
County 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
NOR, FI C:AR01.1 NA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
1. Project Name Cayden Cove
2. Location of land -disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street US 97 Latitude 35.8106 Longitude-78.3887
3. Approximate date land -disturbing activity will commence: March 2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 62.00
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Wesley Smith E-mail [e-mail]
Telephone [phone] Cell # N/A Fax # N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Lennar Carolinas, LLC
919-465-5900 [e-mail]
Name(s)
Telephone Fax or E-mail address
1100 Perimeter Park Drive Suite 112
1100 Perimeter Park Drive Suite 112
Current Mailing Address
Current Street Address
Morrisville NC 27560
Morrisville NC 27560
City State Zip
City State Zip
8. Deed Book No. Page No.
Provide a copy of the most current deed.
Part B.
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):
Lennar Carolinas, LLC
[e-mail]
Name
E-mail Address
1100 Perimeter Park Drive Suite 112
1100 Perimeter Park Drive Suite 112
Current Mailing Address
Current Street Address
Morrisville NC 27560
Morrisville NC 27560
City State Zip
City State Zip
Telephone [phone]
Fax Number N/A

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Telephone
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 Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Telephone
Fax Number
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.
Robert S art
Type p i t e
4_
Sign ure
Vice President
Title or Authority
Date
a NotaryPublic f the County of
State of North Carolina, hereby certify that w+-- (T40 r appeared
personally before me this day and being duly sworn acknowledged that the above foram was executed by him.
Witness my hand and notarial seal, this _2day of'jig Yl VLu fr/ 20 Z�
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