NCC230703_FRO Submitted_20230317

Durham City/County
Sedimentation and Erosion Control
JCN
(Office Use Only)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
!0) 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:_ ACAT Campus (Formerly 6 DAVIS DRIVE BUILDINGS 3 & 4 — PHASE 2)
2. Road location of land -disturbing activity: 6 DAVIS DRIVE RTP
Tax Map - Block - Parcel: 157816 PIN: 0748-03-02-9361
3. Square footage of land to be disturbed or uncovered: 10.67 AC (464,785 SF)
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
ARE -NC REGION NO. 14 LLC
Name
12 Davis Drive
Address
REASEARCH TRIANGLE PARK. NC 27709
City State zip
919-313-6645 OSHERRILL(a)ARE.COM
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.
ARE -NC REGION NO. 14 LLC
Name
12 David Drive
Street Address
RESEARCH TRIANGLE PARK, NC, 27709
City State zip
919-313-6645 OSHERRILLAARE.COM
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, 51' Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.co.durham.nc.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:
OLIVER SHERRILL
Name
12 Davis Drive
Street Address
RESEARCH TRIANGLE PARK, NC, 27709
City State Zip
919-313-6645 OSHERRILL(a,ARE.COM
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.
s125-12 2 OLIVER SHERRILL
Date Type or Print Name
919-313-6645 SENIOR VICE PRES ENT -REGIONAL MARKET DIRECTOR
Telephone Fax /,�j Title o gority�
/ILYTTT.IT\T1TT T r� ♦ TT raw T
Email
Business Applicant (Provide corporate resolution on signatory authority
I, go_br na N JUnkin.S , a Notary Public of the County of ­bu(ham
State of Kbr-%l 6qj j) j kjo hereby certify that aiye'r 5herr-01
personally came before me this day and acknowledged that he
- ��- fir• -�N ��
of A1T-Nc RPAicr) No. 14 ,LLC and acknowledged, on behalf of A eWaMna
` pTAO N
Inc. the due execution of the foregoing instrument. Z 14 t
AUeUG U
Witness my hand and official seal, this 125 day of Nav 2�
1.26-1,� ®®
\" Notary Public
My commission expires JunUO ru ? (p , 20�(_. _
Individual Applicant
I, , a Notary Public of the County of
State
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
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.
S/ZS' (2 2 OLIVER SHERRILL
Date Type or Print Name
919-313-6645 SENIOR VICE MSIDENT-REGIONAL MARKET DIRECTOR
Telephone Fax -I // Y-it§epr A
Email
Business Landowner (Provide corporate resolution on si ng atory authority)
I, Sabrina N 3un Vir6 a Notary Public of the County of _bUrha hr1
State of N� C_arbVhG- hereby certify that Oliver Sherri I1
personally came before me this day and acknowledged that he is SM(Or'ylI e �VSIC6' Idr1G 1 Yk.B► ,�1Ce NI,
of A NC Reftri No 14, LLC and acknowledged, on behalf of Alexondrta (leal ES
U1'iles, Inc. ,,the due execution ofthe.foregoing instrument. C `.tom I9j. Z�
Witness my hand and official seal, this 2s day of M&IJ 201 L1G V .�
lop,
TL lt�
Notary Public if ���\
yexpires.�.�(1inU6V 26 ,20 26 11i1111to�`_
TA
M commission
Individual Landowner
I, , a Notary Public of the County of
State
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.
My commission expires 20
day of
Notary Public
20
SE-03 Rev.07/06