NCC240528_FRO Submitted_20240318

DURHAM ' JCN
COUNTY ' Durham City/County (Office tse Only)
Sedimentation and Erosion Control
13E0 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
• 1881
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: ACLSD Site Grading Extension : Yes or No
2. Road location of land-disturbing activity: 2000 Ellis Road
Tax Map- Block- Parcel: 225021 PIN: 0749-06-62-1857 Square
footage of land to be disturbed or uncovered: 3 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):
ARE-NC REGION NO 19 HOLDING, LLC
Name
PO Box 847
Address
Carlsbad, CA 92018
City State Zip
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 Oliver Sherrill,Senior Vice President,Regional Market
Name
12 Davis Dr.
Street Address
Research Triangle Park NC 27709
City State Zip
919-313-6645 919.993.3439 os her till@a re.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,5'" Floor,Durham,N.C.27701 •[phone]•Fax[phone]
www.co.durham.nc.usiceng

• Ilan 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 Dr.
Street Address
Research Triangle Park NC 27709
City State Zip
919-313-6645 919.993.3439 osherrill rr,are.com
Telephone Fax Email
7. fhe 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.
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Date,„ C? Type or Print Name
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Telephone Fax Ttr Ku Grit
Email Signaler
Business Applicant(Provide corporate resolution on signatoty authority)
I, St;+b+rinQ N (kAl kmrt_C ,a Notary Public of the County of 17u►'hG 1le1
State of NO(*) _[(rM iiA0, ,hereby certify that 1511v/tr Sie err,I
personally came before me1 this
_Iday and acknowledged that he is SVP- Reeinna1 MOr/'�ket Dire 4 1(-
ofAE-NC ion 1I Vitklin,Lt.0 and acknowledged,on behalf of R�exandvi& KQI'.1i 6+u4e
Eql� -h& , int. J ,the due execution of the foregoing instrument.
Witness my hand and official seal,this 23 day of c](,1f1Q. ,20 23 •`�,>lllllff/��/
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My commission expires c)(.lnt lay, 2,6 ,20 Z(o NQ
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Individual Applicant q,�g 28 �0``�
I, a NotaryPublic of the Countyof' �i C •��
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State of ,hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by there.
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 ICCtit 8 for each landowner listed in Item 4.
8. Land Owner Consent. As a landownei, I provide my consent for land-disturbing activities to occur on the properly listed in
Item 2 by the person or entity listed in Item 5.
(o)23123 .6Iiver Sherrill
Date Type or Print Name
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Telephone fax itlE o An
Email Signature
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Business Landowner(Provide corporate resolution on sienalory authoritvl
I,_SCialticKLIS,LkinkinS, ,a Notary Public of the County of DurhAhel
State of J0(- 1 Caroline. ,hereby certify that 0Illier cShCirvi(I
personally came before me this day and acknowledged that he is svp- t' 1(Cc r
of ARC-NC QESItN 1 A H9klir►oy,LAX. and acknowledged,on behalf ofbehalf of Pkglirldr ib. Q[GI C,.S+O+-.011H1///ft/
0.Eq ui his . int.. ,the due execution of the foregoing instrument. 4:1' 0��� N✓G.1�
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Witness my hand and official seal,this ,�3 day of One_ ,20 t
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No ary Public .,•••'3y `''BLIG
My commission expires c bhU(t��.l lb ,20 2b . 1- *4?8.28
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Individual Landowner
I, ,a Notary Public of the County of __
Stale 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
SE-63 Ne.07/06