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Home My WebLink AboutNCC242302_FRO Submitted_20240731 CARY NORTH CAROLINA — Stormwater Division FINANCIAL RESPONSIBILITY-OWNERSHIP FORM No person may initiate any land-disturbing activity covered by Cary's Sedimentation and Erosion Control Ordinance before completing and filing this form with the Cary Stormwater Division. Indicate N/A if a question is not applicable. Section 1 PROJECT NAME: TowneBank Cary PROJECT DEVELOPMENT PLAN#: 23-DP-8285 PROJECT LOCATION: PIN#0754337530 Property Tax ID#/PIN 3791 NW Cary Parkway Street Address APPROXIMATE DATE OF PROJECT INITIATION: 4-1-2024 ACREAGE OF LAND TO BE DISTURBED: 1.60 APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2 of the Financial Responsibility/Ownership (FR/O) Form.) TowneBank Name(Person or Firm) Section 2 PERSON(S) OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY: (If out of state, a registered agent in North Carolina must be used.) Charles Morrell, SVP TowneBank Name(Person or Firm) 3535 Glenwood Avenue Street Address(No PO Box) Raleigh,NC 27612 City State Zip Cary 316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005 Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov updated:04/2023 757-693-1624 Telephone Number N/A Fax Number charles.morrell@townebank.net E-Mail Address REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE: (If out of state,a registered agent in North Carolina must be used.) Williams Mullen Name 301 Fayetteville Street,Suite 1700 Street Address(No PO Box) Raleigh,NC 27601 City State Zip 919-981-4000 Telephone Number 919-981-4000 Fax Number eschenk@williamsmullen.com E-Mail Address The Town res s the right to contact either the financially responsible person or registered agent listed below in e o iolation. Please indicate your preference below. - 5-VP OR Finan ally Res nsible Person Registered Agent Section 3 LANDOWNER OF RECORD. TowneBank Name(Person or Firm) PIN#0754337530 Property Tax IDA/PIN 3791 NW Cary Parkway Street Address(No PO Box) Cary,NC 27513 City State Zip Cary 316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005 Tel: 311 or 919-469-4000 outside Cary limits www carync.gov Page 2 of 3 updated:04/2023 STATEMENT OF LANDOWNER CONSENT In accordance with NCGS 113A-54.1(a), I hereby declare that I am the owner or legally authorized representative of the owner of the property described above and provide my consent for the applicant cited in Section 1 above to submit an erosion control plan to the Town of Cary Stormwater Division and to conduct the planned land-disturbing activities on the property listed in Section 1 above. Charles Morrell Senior Vice President Name ✓ Title or Authority P ')///12 Signet re Date charles-morrell@townebank.net 757-673-1624 Email Telephone Number THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided by me while under oath. (This form must be signed by the financially responsible person, if an individual or by an officer, director, partner, attorney-in-fact, or other person with authority to execute instruments for the financially responsible person if not an individual.) Charles Morrell Senior Vice President Type or I-'ypt Nvrne/ Title or Authority 5-Up /0ci Signature Date I, The r-e so.. Tb , a Notary Public of the County of C.ta.rt 1 -rtick State of North Carolina, hereby certifies that No.(t-e alprfe,( personally appeared before me this day and under oath acknowledged that the above form was executed by him/her. +I Witness my hand and notarial seal,this I 0 day of� 1 , 202 q rr Y~�ieal j 1,Q ' I • • , uju"jet, L00.;...ivu Notary Public � My commission expires Oj4,L27 �2y . r ♦ rr • Cary 316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005 Tel: 311 or 919-469-4000 outside Cary limits www.carync gov Page 3 of 3 updated:04/2023