NCC232310_FRO Submitted_20230815

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
0 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
1881> 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: Olive Branch Reserve Sewer Outfall-Pulte Portion
2. Road location of land-disturbing activity: 1607 Olive Branch Road
Tax Map-Block-Parcel: 194195 PIN: 0860-74-72-2930
3. Square footage of land to be disturbed or uncovered: 101,768 sq ft
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
Pulte Home Company,LLC
Name
1225 Cresent Green Drive,Suite 250
Address
Cary NC 27518
City U.-w.1 State Zip C,,,14i i S . C au►g1n�e.-1 & pw l.6 5 o.s?.Go,r►1
919-0MlA498114 c
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.
Pulte Home Company, LLC
Name
1225 Crescent Green Drive,Suite 250
Street Address
Cary NC 27518
City llb1 State Zip Gln.ric . r0.H9l.xLy a pv.t4 . jroup.Gam
919 l
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.
• Refer to Section 12.10.4B 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., 1st Floor,Durham,N.C. 27701 • [phone]•Fax[phone]
www.dconc.gov/index.aspx?page=180

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Chris Raughley
Name
1225 Crescent Green Drive,Suite 250
Street Address
Cary NC 27518
City State Zip
919-816-1161 [e-mail]
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: (l) 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.
1/9/23 Chris Raughley
Date Type or Print Name
919-816-1161 VP Land Development
Telephone Fax T. le or Aut)ty
[e-mail] ,^it
Email Signature
Business Applicant(Provide corporate resolution on signatory authority)
I,MQAt ii `iVh.aa ,a Notary Public of the County of W �
State of /v(/ ,hereby certify that V"Y1 S h
personally came before me this day and acknowledged that he is V 1 C,¢ Pvt.s i of ei,--v{-
of 1,0tYvC 'De V 6 0V' t2 A41 _and acknowledged,on behalf of r"` +AD M4..- GO 1✓Y.pet YU)
1 �✓J
,the due execution of the foregoing instrument.
Witness my hand and official seal,this i E day of J at4Wt43..w ,20 2-5
Notary Public -fi \SP S`V1
My commission expires j 21 20 '1 �` �• •
,,2's
� OTAR�,,-v'
************************************************************************************************************* ***4**************
I ,
Individual Applicant 4\ A(j8 LAG ,%0
I a Notary Public of the County of
CO U
"*Iz l,[IU,,,,,,t`
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
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.
1-9-23 Pulte Home Company,LLC by Chris Raughley
Date Type or Print Name
919-816-1161 VP Land Development
Telephone Fax Title or Authpri�y
[e-mail] �/ ,„/�.
Email Signature Y o
Business Landowner(Provide corporate resolution on signatory authority)
I, (111Q�l�II 51�1Qii �Letia- ,allotaryPublicoftheCountyof vvoi,
State of (J C/ ,hereby certify that CA l PIS )►t
personally came before me this day and acknowledged that he is V i f)rtg` Ol
of U#AV p(w.d.hteyo ." and acknowledged,on behalf of Pt/vc-n`---`btM{ (-omit/mil ,
wL ,the due execution of the foregoing instrument. �" JJ
Witness my hand and official seal,this it day of jon414 ,20 1.3
01 ``,,111111111717//�
Notary Public ,�.l`l�SA S/y�''%
it'd
My commission expires ���c L1 Z ,20 1i ;/��.,-
J 0TA , 2=
-
Individual Landowner Et Z.
I , a Notary Public of the County of $L 1 G aV
CO
State of ,hereby certify that o�o'' 7UN� 1���
I `(`'
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.10/13