NCC242296_FRO Submitted_20240729

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
O 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: Copper Run North Extension: Yes or No
2. Road location of land-disturbing activity: 2040 Copper Leaf Parkway
Tax Map-Block-Parcel: 199244,203360, 199238 PIN: 0759-09-89-6042,0759-09-96-8229,0759-09-21-1779
3. Square footage of land to be disturbed or uncovered: 517,789 SF(11.89 AC)
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
Forestar(USA)Real Estate Group Inc.
Name
10700 Pecan Park Blvd.,Suite 150
Address
Austin,TX 78750
City State Zip
919-309-5291 N/A [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.
Forestar(USA)Real Estate Group Inc.
Name
8041 Arco Corporate Drive#110
Street Address
Raleigh,NC 27617
City State Zip
919-309-5291 N/A [e-mail]
Telephone Fax Email
eeYrdt As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
(initials) communication at [e-mail]
(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,5"'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
1-866-403-5272 N/A
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.
July 26,2024 Jason Rivenbark
Date Type or Print Name
919-309-5291 N/A VP,Real Estate Inves ent&Development
Telephone Fax Tit r"ft:[e-mail] _
Email Si ature
Business Applicant(Provide corporate resolution on signatory authority)
I Christy Messer ,a Notary Public of the County of Lee
State of NC ,hereby certify that Jason Rivenbark
personally came before me this day and acknowledged that he is VP,Real Estate Investment&Development
of Forestar(USA)Real Estate Group Inc. and acknowledged,on behalf of Forestar(USA)Real Estate Group Inc.
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the due execution of the foregoing instrument. �Q�� 44
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Witness my hand and official seal,this 26th day of July `0° tibTA '
II. Notary ub 'c s p
My commission expires 8/12 ,20 28 "BUG
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Individual Applicant
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.
July 26,2024 Jason Rivenbark
Date Type or Print Name
919-309-5291 N/A VP,Real Estate Investor t&Development
Telephone Fax Tito Aupti
[e-mail]
Email Si ature
Business Landowner(Provide corporate resolution on signatory authority)
I _ Christy Messer ,a Notary Public of the County of Lee
State of NC ,hereby certify that Jason Rivenbark
personally came before me this day and acknowledged that he is VP,Real Estate Investment&Development
of Forestar(USA)Real Estate Group Inc. and acknowledged,on behalf of Forestar(USA)Real Estate Group Inc.
,the due execution of the foregoing instrument. ���``�� ottui 11-Iry M��.""i,
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Witness my hand and official seal,this 26th day o July atT
cP 240TAi , dik
Notary Pub is
My commission expires 8/12 ,20 28 . PUBLIC
Individualonsoilimo-
Landowner
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 Rev.07/06