NCC240082_FRO Submitted_20240111

JCN
4 s; Durham City/County (Office Use Only)
__ Sedimentation and Erosion Control
i FINANCIAL RESPONSIBILITY/OWNERSHIP 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 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: Townes on Leesville Extension: Yes or No
2. Road location of land-disturbing activity: 5202/5214 Leesville Road,Durham NC
Tax Map-Block-Parcel: 193244, 193245 PIN: 0759-96-44-9414, 0759-96-30-2292
3. Square footage of land to be disturbed or uncovered: 958,320 (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):
Beazer Homes LLC
Name
801 Corporate Center Drive—Suite 330
Address
Raleigh NC 27607
City State Zip
919-995-5607 RLH-LandDepartmentAbeazer.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.
Beazer Homes LLC
Name
801 Corporate Center Drive—Suite 330
Street Address
Raleigh NC 27607
City State Zip
919-995-5607 RLH-LandDepartmentAbeazer.com
Telephone Fax Email
As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
(Initials) communication at matt.christensen@`beazer.com
(Email Address)
I agree to provide any updated email addresses as necessary to ensure consistent communication is maintained between myself
and Durham County Sedimentation and Erosion Control.
Electronic notifications may include Plans Review Comments,Approvals,Disapprovals,and/or enforcement actions including
Notices of Violation, Stop-Work Orders,and/or Civil Penalties.
201 E.Main St,5t'Floor,Durham,N.C.27701 •[phone] •Fax[phone]
www.co.durham.nc.us/ceng

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Corporation Service Company
Name
2626 Glenwood Ave Ste 550
Street Address
Raleigh NC 27608
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 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.
/2j V 23 HCl siel-LSC'li
Date Ty e or Print Name
9/9— 5 'f5•5&7 /'t'S�C /- I j f 6
` > t a
Telephone /, Fax T' or thor"
6''?4 CI9it-,SJ'r'YISe°t,fdbe6ae✓-
Email Signature
***********************************************************************************************************************************
Business Applicant(Provide corporate resolution on signatory authority)
I, (-Icon A Skadr1.uc-k ,a Notary Public of the County of L)ake_
State of ,U0r11\ (aro\ n c� ,hereby certify thatC)nr s�cnsP/�
personally came before me this day and acknowledged that he is Pros,aen sicvtAk — Ra.l
and acknowledged,on behalf of 3ea-ter- Hoi es LL C
,the due execution of the foregoing instrument.
Witness my hand and official seal,this f It day of Cc+ober ,2013
Notary Public G 'VT SHADDUC
My commission expires Jun c ILA ,20z6 . NOTARY PUBLIC
Wake County
Individual Applicant My Commission Expires June 14,2028
I, ,a 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
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.
/6 Jy/23 /12�%4fC/'1,2s1 s ,
Date Tile or Print Name
Telephone , Fax Title or uthof
/410T7<< 1✓J51 iS i ba2 et- co?rir
Email Signature
Business Landowner(Provide corporate resolution on signatory authority)
I, C-lrvn'r $1nc.&c9-Kck ,a Notary Public of the County of U t�
State of ,Jo r 4-11 Carol;\- ,hereby certify that \M a CIt rr e e n
personally came before me this day and acknowledged that he is Pres;den. - D; s — Rc.l<<rah
of and acknowledged,on behalf of See- -e r 4or tes LL C
,the due execution of the foregoing instrument.
Witness my hand and official seal,this t-) +h day of Cc,4-c)b�
Notary Public GRANT SHADDUCK
My commission expires 0(Aft 1 H ,20 7.8 NOTARY PUBLIC
Wake County
**************************************************************************************************** ************tiftlfittttd*
Individual Landowner My Commission Expires June 14,2028
I, ,a 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
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.
• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
SE-03 Rcv.07/06