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HomeMy WebLinkAboutNCC242573_FRO Submitted_20240830 JCN DURHAM COUNTY Durham City/County (Office Use Only) Sedimentation and Erosion Control II FINANCIAL RESPONSIBILITY/OWNERSHIP FORM WITH LANDOWNER CONSENT FORM 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: Wabash Parcels Extension: Yes or No Wabash Street and Ridgeway Avenue 2. Road location of land-disturbing activity: Tax Map-Block-Parcel: 117793, 117801, 117802 PIN:0830-27-8950, 0830-28-7207, 0830-28-8247 3. Square footage of land to be disturbed or uncovered: 285,998 SF (6.57 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): Habitat for Humanity of Durham, INC. Name PO Box 11860 Address Durham NC 27703 City State Zip 919-451-7538 jleonard@durhamhabitat.org 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. Habitat for Humanity of Durham, INC. Name PO Box 11860 Street Address Durham NC 27703 City State Zip 919-451-7538 jleonard@durhamhabitat.org T 1 i one Fax Email ' ,<_ As the Financially Responsible Party,I 3 ent to r ceivinnotificati ns rearding this project via electronic nt,ais) communication at , �?yi-16,(0D . , (Email A.dress) 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 •(919)560-0735•Fax(919)560-0740 www.co.durh am.nc.0 s/ceng 6. For business applicants,list below the North Carolina registered agent for the financially responsible entity: ila" 16 uin4•41v` 7 ' 71//rhc(.61 Name PO Box 11860 treet Address urham NC 27703 CityState Zip 919-451-7538 ---", r r- le - 1 h j , 4v) 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. fr k ~joy 0i C lc-1)60,172- Osi& xios (41. Type orPrint Name _ aephone Fax ` 't e or Authori` ithiki4 . Email ignature Business Applicant(Provide corporate resolution on signatory authority) I, (1/0 Ze- (6/ifi iS ,a Notary Public of thee County of W(Ce--K` State of krill Cro4/i it&.. ,hereby certify that r!z )& c� Vuv personally came before me this day and acknowledged that he is a© of IIabst- 6 1-iunlas tiviL,fhow, and acknowledged,on behalf of HG /l? ' ,r tei'ha V1.4 ,the due execution of the foregoing instrument. Witness my hand and official seal,this /S day of A--t ,20 -Z Notary Public My commission expires /(,�41 3/ gl- ,20 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 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. 1/ 02( 1 Da Ty eor Pant Name � � � .. Tee one Fax Ti or Authority Email / S'gnature *********************************************************************************************************************************** Business Landowner(Provide corporate resolution on signatory authority) I, l'G►2n �Or<I i'r6 ,a Notary Public of the County of vo State of NtrT ettrt/lncc, ,hereby certify that 1fa04d TOt1ruu' personally came before me this day and acknowledged that he is of 1-ktbda 6't1CgYl f 101410v4'1 and acknowledged,on behalf of 1I / 0- 4,2nt& PTV +yt ,the due execution of the foregoing instrument. Witness my hand and official seal, this /5—i-k day of M ,20 �4" ekm,,,,2. dabs, � z St.- Public My commission expires `Cl c5t ,20 L9 . Individual 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