NCC242092_FRO Submitted_20240711

OP" 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 Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
,1
7 Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A. j7)1 //��
1. Project Name ``(T ) Z- C5'Y.1 vi G frP yiv) LY/14
2. Location of land-disturbing activity: Jurisdiction 1\i `Z (Wake Co.or Municipality)
Highway/Street L ct /`1+NE.Latitude Longitude
3. Approximate date land-disturbing activity will commence: Z ) Z.3)21-
4. Type of development(residential, commercial, industrial, institutional, etc.): 1 ..S i b -
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): Q. c
6. Person to ontact should erosion and� sediment control issues arise during land-disturbing activity:
Name \^�E � �n� A 4 E-mail Address hikL� ,� ,7��1t.1 jPLC `,.M
t
Telephone 1)T Go 0. 4-7 0 Cell# Fax#
7. L ndowner(s)of Record(attach accompanied page to list additional owners):
Names Telephone Fax or E-mail address
,%so Joocc A tic.
Current Mailing Address Current Street Address
b‘914 rE...t. 1" Pk_ 21-rel
City State Zip City State Zip
8. Deed Book No. 0 1
g133 a Page No. 01 70F) —0/171Novide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
M I KE M A-DA- PA M I KE e DE812 S o tYD4 6 o f�i,) ,cc,ovl
Name E-mail Address
3 G.5O. Ro`i2S 2A 4 33O
Current Mailing Address Current Street Address
14)1)( PeEST ) N L 2'1.58'7
City State Zip City State Zip
q
Telephone ci i / — Goo — y 760 Fax Number

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Pa is a Corporation, giv name and street address of he Registers Agent:
1 is . 1 C 'E Etp S 0,Zi 3,J) ,c6:, u
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
UIA )4t 1V31
G'\ , Z 7�5 7
City State Zip City State Zip
(_ �
Telephone Wv0. 27a
P 9 � 1 Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Nt 1 GltfNL L L !-'11 nA CIA-GA PILE-+y 1 D f=7,.1 1
Jype.or-puma Title or Authority
7
:—____:___ i 0 i 0 Z._ ZDZ:1:7"
eStgriature Date
I, ., �',fe is 642Lz Le,17 ,a Notary Public of the County of G►/„ /--//G
State of North Carolina, hereby certify that /Z /C-4//('/,_ t - /Z2/1-i)rte//1-6;4 appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal,this —3' day of QC (2.'*----.; ,20,
Ti1]Yiu Barklsy _ /lam
NOTARY PUBLIC __. ... ..:
V t aunty,NC N ary
My CommIssIonrxplres February 20,2027
My commission expires t, -G '��t, 2,7

10111111 Wake County Real Estate Data Home iMaps
Account Summary COMPER Tax Bills
„000.1 11/1 Real Estate ID 0502721 PIN# 1812998442
Account
'WAKELocation Address Property Description Search
1613 LEGACY RIDGE LO12 GRAND HIGHLAND ESTATES PH1 BM2022-
COUNTY
O TNT i LN 02321 Pin/Parcel History Search Results New Search411
IProperty Owner 'Owner's Mailing Address ' Property Location Address I
1 DEEP SOUTH BUILDING COMPANY INC 3650 ROGERS RD#330 11613 LEGACY RIDGE LN
(Use the Deeds link to view any additional owners) WAKE FOREST NC 27587-9306 WAKE FOREST NC 27587-1502
Administrative Data I Transfer Information I Assessed Value 1
I Old Map# 164-.. I I i
1 Map/Scale 1812 02 I Deed Date 5/12/2023 I Land Value Assessed $350,0001
VCS 14WC131 Book&Page 19332 1709 ;Bldg.Value Assessed
'City Revenue Stamps 390.00 1 1
!Fire District 23 Pkg Sale Date I
Township NEW LIGHT Pkg Sale Price Tax Relief 1
i Land Class VACANT Land Sale Date 5/12/2023 { I
ETJ WC Land Sale Price $195,000 I Land Use Value
Spec Dist(s) I Use Value Deferment •
Zoning R-40W Improvement Summary Historic Deferment
History ID 1 Total Deferred Value I
,History ID 2 I Total Units 0
i Acreage 2.19 I Recycle Units 0 ,
Permit Date !Apt/SC Sqft I Use/Hist/Tax Relief I
I Permit# ' Heated Area ;Assessed
Total Value Assessed* $350,0001
*Wake County assessed building and land values reflect the market value as of January 1, 2024,which is the date of the last
county-wide revaluation.Any inflation,deflation or other economic changes occurring after this date does not affect the
assessed value of the property and cannot be lawfully considered when reviewing the value for adjustment.
The January 1, 2024 values will remain in effect until the next county-wide revaluation. Until that time, any real estate
accounts created or new construction built is assessed according to the 2024 Schedule of Values.
For questions regarding the information displayed on this site, please contact the Department of Tax Administration
at [e-mail] or call 919-856-5400.