NCC242965_FRO Submitted_20240925

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: Lewey Drive Townhomes
PROJECT DEVELOPMENT PLAN #: 738186/22-DP-8469
PROJECT LOCATION:
0733863080
Property Tax ID#/PIN
6705 Lewey Dr
Street Address
APPROXIMATE DATE OF PROJECT INITIATION: 8/12/24
ACREAGE OF LAND TO BE DISTURBED: 4.02 Acres
APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2
of the Financial Responsibility/Ownership (FR/O) Form.)
My Door at Turner Creek, LLC
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.)
My Door at Turner Creek, LLC
Name(Person or Firm)
2300 Rexwood Drive, Suite 120
Street Address(No PO Box)
Raleigh, NC 27607
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.cov
updated:04/2023

919-800-0460
Telephone Number
Fax Number
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RFSPONSIBLE.
(If out of state, a registered agent in North Carolina must be used.)
Zach Lauenstein, Blue Heel Development
Name
2300 Rexwood Drive, Suite 120
Street Address(No PO Box)
Raleigh, NC 27607
City State Zip
336-404-0632
Telephone Number
Fax Number
[e-mail]
F-Mail Address
The Towm escrow-the-rigtrt-to--contact-either-the-fineneially-responsible-persr n-oF registered agent-listed
below in case of violation. Please indicate your preference below.
Zach Lauenstein
Financially Responsible Person Registered Agent
Section 3
LANDOWNER OF RECORD:
My Door at Turner Creek, LLC
Name(Person or Firm)
0733863080
Property Tax IN/PIN
2300 Rexwnoci Drive Suite 120
Street Address(No PO Box)
Raleigh, NC 27607
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.
Wallace oves�(- Manager
Name `_�\�� } Title orA/ufhority7[f
attire Date
kyle(a�blueheelgroup.com 919-800-0460
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.)
Wallace yes Manager
orPnn ame Title or Authority
Signature Date
I, U(CA1 Y-e)yc)( , a Notary Public of the County of �v�YL1L.� ,
State of North Carolina, hereby certifies that l .JQ ('0 � O))WNP<
personally appeared before me this day and under oath acknowledged tfia't the above form was
executed by him/her. pp /�
Witness my hand and notarial seal,this LQ day of CJOC - ,
.��\`r KOL4'Q/1
J+ N0i ARC
_ = Notary Public
11M6. p28
P Bt\G �V\ My commission expires 46124( 2vZtP
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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

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