NCC231756_FRO Submitted_20230608

JCN
/ D U R H A M COUNTY pR)ce Use Daly)
Durham City/County
Sedimentation and Erosion Control P FORM
�O FINANCIAL RESPONSIBILITY/OW FORM• leaf •••
WITH LANDOWNER CONSENT
No person may initiate any land-disturbing activity covered by the Durham City-County Unified Development Ordinance
' does not
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Di rui Disturbing
by Federal, State,
efore a
relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may q
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: 10311 Rougemont Road—Parker Residence
Extension: No
2. Road location of land-disturbing activity: 10311 Rougemont Road Durham NC 27503
Tax Map-Block-Parcel: 189425 PiN: 0818-56-72-3185
3. Square footage of land to he disturbed or uncovered: 53,185 sq ft.=1.22 acres
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
Cody and Joy Parker
Name
10311 Rougemont Road
Address
Durham North Carolina 27503
City State Zip
919-730-1595 nia Jet1595laemail.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
Cody and Joy Parker
Name
10311 Rougemont Road
Address
Durham North Carolina 27503
City State Lip
919-730-1595 n/a Jet1595(a7gmail.com
Telephone Fax Email
The Sedimentation and Pollution Control Act (Act) and the Durham City-County Unified Development Ordinance
tOrdinance)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.
• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
201 E.Main St 5"Floor,Durham,N.C.27701•[phone]•Fax[phone]
w ww.cu.d urb am.a C uw Q a 1

f
6. For business apppcants.list below the North Carolina registered agent for the financially responsible entity:
Name
Street Address
City State 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
hewn is 0a sued.
understand that the person or entity listed on Line 5 above will be:(1)the owner of the Land Disturbing Peron with standing to
(2)responsible for ensuring compliance with the Act and Ordinance;and,(3)will be the only person or entity
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
Cody Parker
Print Name
919-730-1595 nia /
Phone Number Fax Number / -_S-a0,?3
Jet1595(a�Qmail.com "j G Date
Email !}T
Joy Parker
Print Name
919-730-1595 nia
Phone Number Fax Num
Jet 1595 — Jc))U(a.trmail.eom
Email nue Date
I, \.tr\n ynnue1'l 1,_, QWpr ,a Notary Public of the County of C"SYQ.YIV I j l-e_
State of 0C_, ,hereby certify that Codv Parker
personally appeared before me this date and under oath acknowledged that the above form was executed by him. `tutu t t t 11Irri�
Witness my band and official seal,this of 5 day of A p V i I 20 02 3 Z%%O e n o n 4. O�''
� i. 1.
tor,/
No Public r.0
�9N
Io) 30 20a`� =; teuc
My commission expiresL/,, G`:
1, sk1a11a 1 n, L oW/2 19 ,a Notary Public of the County of (7YA'.t'1✓t 1 I e
State of l 1 , ,hereby certify that Joy Parker
personally appeared before me this date and under oath acknowledged that the above form was executed by her.
Witness my hand and official seal,this . .5 day o }j�Y I I ,20 pr3
,I'1 ,,,tttttrr,,,,
r 1 f„. annon '...
o Public ` `' Z. eo,
1 n -
My commission expires 1(11O 20 d4 NO,.1 F.to '9 to 7.
i 6<lC
LAND DISTURBING PERMITS ARE NON-TRANSFERABLE ,gym .
G .`