NCC230678_FRO Submitted_20230314

DURHAM
COUNTY
0:91
Durham City/County
Sedimentation and Erosion Control
JCN
(Office Use Only)
FINANCIAL RESPONSIBILITVOWNERSHIP 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 pernittee 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 tliis form.
PLEASE TYPE OR PRINT
1. Project name: Vjj%t:AG G VhY ,V_tt'°S, Jtj 10
2. Road location of land -disturbing activity:
Tax Map - Block - Parcel:
3. Square footage of land to be disturbed or uncovered: 0 • 401 6c,
PIN: OQj D " Dl -2 b- 0 . J7
4. List below the landowner of record. Each landowner must complete Item 8.
(If 14ere are multiple owners, please list on a separate page):
Name 5 J 1 S AA S+uo A� • STC - gi O
Address
City State Zi
7 r.R - 3-3Lf S 5 k, 0, -- -��O -evl S 0_►-1 @ C(A' ( VV1W - co-�q
Telephone Fax
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 t11e land -disturbing activity or have benefited from it and (3) the named party on the Land Disturbing Permit.
Name
f i2Q I - iv //2 �-
Street Address
0(14?f 0-- Ro Tn/ -2 -7/ �a
City State Zip Cp
lO l J S
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:
IF 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.,1" Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
,wv-%i-iv.deone.gov/lndex.aspx?page-180

6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
it Pais+erel Aa4Ryyvc_ 2nL.
Name
Address
c t', Sv,, — - 'Zo 00
Zip
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.
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Telephone Fax Title or A n
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Email Signature
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Business Applicant (Provide corporate resolution on sisnatory authori
I, Per_(_ . /'i <: OA f , a Notary Public of the
County of �l'
tn-nc r' 1" or , -A -
State of l�i�i ri@ S'�'e� ►
,hereby certify that I i n ! � �'1 Ice r!!k C �1
personally came before me this day and acknowledged that he is _l �D� r 10, 041ef'
of V 1(1� Dfnrl"Im ON� "and acknowledged, on behalf of Vj /� 1yA j9wr t�r/'Y)
Ir,inef, c .,jthe due execution of the foregoing instrument.
Witness my hand and official seal, this 1S day of �H f 1 C 1 - 19.AA!?�s
Notary Public vt-
My commission expires O ��� , 20 0�. TENNESSEE
O NOTARY
n PUBLIC
Individual Applicant
I, , a Notary Public of the County of
State of . hereby certify that
� � OF
gyp,,.
-""M E7CPIRES
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, Viis
My commission expires
20
day of
Notary Public
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 activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
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Business Landowner (Provide corporate resolution on signatory authority)
I, NICOLE MAMEWS , a NotaryPublic of the County of WC(..I�_
State of AA , hereby certify that J e rt Y-E' -1 - 14 •
personally came before me this day and acknowledged that he is ?" S I CLX. q f
of _ 1 D V f Y , L-L- L and acknowledged, on behalf of ` - ke- C w1oa yi si_
``t\�t`���tt►tttlttO "' the due execution of the foregoing instrument.
Witness d and official seal, this I D+) day of J (,L �% P_ _, 20
JA
�" Notary Public NICOLE MATTHEWS
.► Nf,nis expires `� C (y , 20.Z4.
OLINA
i�uai Landowner
Notary Public of the County of
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 , 20
Notary Public
My commission expires 20
SE-03 Rev.10113

WRITTEN CONSENT OF THE MANAGER OF
HD TOWER, LLC
The undersigned, being the Manager of HD TOWER, LLC, a North Carolina limited
liability company (the "Company"), does hereby adopt the following resolution by signing his
written consent hereto.
GRANT OF POWERS TO
DREW CUNNINGHAM AND JEFFREY A. BENSON
WHEREAS, the Manager deems it to be in the best interest of the Company to appoint
Drew Cunningham ("Cunningham") as Chief Operating Officer of the Company, with the
authority to execute any and all lease agreements, management agreements and related asset
enhancement contracts, for and on behalf of the Company.
WHEREAS, the Manager deems it to be in the best interest of the Company to appoint
Jeffrey A. Benson ("Benson') as President of the Company, with full and complete authority, to
execute any and all documents as required to manage and control the business of the Company,
including but not limited to, any and all documents related to any mortgage financing entered into
by the Company.
NOW, THEREFORE, BE IT HEREBY:
RESOLVED, that Cunningham be, and hereby is, authorized, to execute and deliver on
behalf of the Company, any and all lease agreements, management agreements and related asset
enhancement contracts, for and on behalf of the Company.
RESOLVED, that Benson be, and hereby is, authorized, to execute and deliver on behalf
of the Company, any and all documents as required to manage and control the business of the
Company, including but not limited to, any and all documents related to any mortgage financing
entered into, for and on behalf of the Company.
These actions and resolutions are effective as of February I , 2017.
HD TOWER MANAGER, LLC
Anthony . Dilweg, Manager