NCC241795_FRO Submitted_20240612

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
Q 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
Petchel Residence
1. Project name:
2. Road location of land-disturbing activity: 6878 Stagville Rd, Bahama, NC
Tax Map-Block-Parcel: BM 190 PG45 PIN: 0846395940
3. Square footage of land to be disturbed or uncovered: 74,487
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
The Elwood L. Petchel Revocable Trust; The Sharon Petchel Revocable Trust
Name
6878 Stagville Rd
Address
Bahama NC 27503
City State Z i p
570-262-9309 [e-mail]
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.
Bost Construction Company
Name
8255 Chapel Hill Rd
Street Address
Cary NC 27513
City 919-460-1983 State [e-mail]
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,5th Floor,Durham,N.C.27701 •[phone]•Fax[phone]
www.co.durham.nc.us/ceng

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 y the rson or entity listed in Item 5.
3ALA Liri wo ocal L . Pe# hei
Date
or Name
S1 o -AG , - 93o9 rus ee.
Tele hope Fax TitlrrAuthori P
Wood►. pet4Ae 'off 1nota-t/. corvt
Email J Signature
Business Landowner(Provide corporate resolution on signatory authority)
I, ,a Notary Public of the County of
State of ,hereby certify that
personally came before me this day and acknowledged that he is
of and acknowledged,on behalf of
,the due execution of the foregoing instrument.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires ,20
*********************************************************************************************************************************
Individual Landowner A���!
I, Vain
AQ✓t go54— ,a Notary Public of the County of (AJ4"
State of Nd r4 COL co t •frC ,hereby certify that 014.7004) L• �Q r
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 Z- day of /t/l�rtik ,20
f Z Public \`\\\\��`�v AN g ps ..;:„
My commission expires 17( /'0Z-1 20 Z� °tea Public
Wake
County ;-
Notary
SF,-o.3 — My Corn
O 04-12 0
9
i CAR ,,\`
,/orilniin \\\�t'

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 e p n or entity listed in Item 5.
3g � q rn PeI' Jie /rLv
Date Type gr Print/*x�mme
,570'9519 - 1DV / lru_S-ree-
Teleonc 1 Fax Te or Authority
ttitilL
e C e 1 a 9 0? nos • co/ .- p
Email Signature
Business Landowner(Provide corporate resolution on signatory authority)
I, ,a Notary Public of the County of
State of ,hereby certify that
personally came before me this day and acknowledged that he is
of and acknowledged,on behalf of
,the due execution of the foregoing instrument.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires ,20
Individual Landowner
I, CVo.,.". & S+ ,a Notary Public of the County of G./a
State of /vo'Y{ lac(or'& _ ,hereby certify that Shq tro V1 �'2 h 4-e
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 iS44-` day of /AA-N C k ,20 7-4(
`,�0\111 n 1 u uiii/
�'// Notary Public \\\.�`\ �P� USA '%'�'
My commission expires 1021Z021 20 Notary Public
_ Wake
County _
SE�ba My Comm. Exp.
2 U4-12 -
''2I 1//C A1R\?\\�\��

• Plan 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:
Rex A. Bost
Name
8255 Chapel Hill Rd
Street Address
Cary NC 27513
City
ty19-460-1983 State [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: (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.
3/28/2024 Eric Sherman
Date Type or Print Name
919-460-1983 Operations Manager, Bost Construction Company
Telephone Fax 'tle or Authority
[e-mail] {
Email Sign
Business Applicant(Provide corporate resolution on signatory authority)
I, eVd-n ,a Notary Public of the County of (0jA
State of /144 C tortes r ,hereby certify that Eric Sherman
personally came before me this day and acknowledged that he is Operations Manager
I
of Bost Construction COmpanyand acknowledged,on behalf of Bost Construction cb'i p. , ''`Sj ICd��Ji
,the due execution of the foregoing instrument. Notary
W Public
4-rfi Witness my hand and official seal,this .7 2 day of 20 Cauntyake My Comm. Exp.
' 04-42'2Q27 `a
j� Notary Pub `�
My commission expires 7 f j /e 20 {`> H C
Individ
ual Applicant
I, CC) a Notary Public of the County o
State of m°a er Piety ,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 d ,20
Notary Public
My commission expires 20
LAIND DISTURBING PERMITS ARE NON-TRANSFERABLE