NCC232377_FRO Submitted_20230808

"WI WAKE COUNTY FINANCIAL RESPONSIBILITY:OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo person may initiate any land-disturbing activity on one or more acres as covered by the Wake
County Unified Developent Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control planm Rave been completed and approves, by Wake County Department d
Environmental Services. Water Quality Division. (Please type or pnnt and. if the question is not
applicable,place NIA in the blank.)
Part A.
t Protect Name Lot 24 Southern Hills
2. Location of land-disturbing activity. Jurisdiction Wake (Wake Co.or Municipality)
Highway/Street Sky Vista Way latitude 35.958370 Longitude -78.688698
3. Approximate date land-disturbing activity will commence: 8/1/2023
4. Type of development(residential.commercial,ndusbial.institutional.etc.)_ residential
5 Total acreage disturbed or uncovered (ncluding oft-site utilities and borrow/waste
areas) 0,7
6 Person to contact should erosion and sediment control issues arise during land-disturbing activity.
Name Samuel St.Clair II E-mail Address [e-mail]
Telephone [phone] Cell tt Fax#
7 Landowner(s)of Record(attach accompanied page to list additional owners),
Jean and Geoffrey You 551-580-1522
Name(s) Telephone Fax or E-mat address
1408 sky vista way,raleigh 27613 1408 sky vista way,raleigh 27613
Current Mailing Address Current Street Address
Raleigh,NC 27613 Raleigh,NC 27613
City State Zip City State Zip
8 Deed Book No_ 019175 Page No. 00102 Provide a copy of the most current deed
Part B.
I Person(sl or firm(s) who are financially responsible for the Iand.dtsturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet Include requested information):
St.Clair construction group LLC [e-mail]
Name E-mail Address
1619 Oberlin road 1619 Oberlin road
Current Mailing Address Current Street Address
Raleigh,NC 27608 Raleigh,NC 27608
City State Zip City Stale Zip
Telephone [phone] Fax Number

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