NCC243066_FRO Submitted_20241004

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WA �L No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
L`11�L County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been competed and approved by Wake County Department of
NttNfN CAFiIIN♦ Environmental Services. Water Quality Division. (Please type or print and. if the question is not
applicable. place NIA in the blank.;
Part A.
1. Project Name Lot 7 Randell Property
2 Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
:Highway/Street'3813 C1de Creedm()Qr Roadiatitude 35.99r21 deg N Longitude 78 09496 deg W
3 Approximate date land-disturbing activity will commence. August 15,2024
4. Type of development(residential, commercial. industrial, institutional, etc.): ' ^ic-'^
5. Tota acreage disturbed or uncovered (-including off-site utilities and borrow/waste
areas): 08t are
6_ Person to contact should erosion and sediment control issJes arse during land-disturbing activity:
icn Ward
Name E-mail Address i°f1'i"j"'7t7urldingCampSr7y cxr
Telephone_919-280-2107 Cell# 91s-780-210r Fax
7. Landowner(s)of Record (attach accompanied page to list additional owners):
1 2 Guiding Company.LLC 91S-280-2107 jar@lW2buildingoanpany rt)m
Name(s) Telephone Fax or E-mail address
2125 Pins Drive 2125 Fine Drive
Current Mailing Address Current Street Address
Raleigh, NC_27808 Ra jh NC.27608
City State Zip City State Zp
8. Deed Book No. 019b00 Page No. 0017F Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are hnancialiy responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet Include requested information):
Y�9 Rvlding Company LI_C ipn4 rocauildingeompany.ocrn
Name E-mail Address
)12s Pre Drive 2125 Pine Drive
Current Mailing Address Current Street Addres
Raleigh, NC. 27608 Raeigh. NC. 27608
City State Zip City State Zip
Tclophone r Fax Number

2. (aj 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 arming out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance andlor 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 Pa.'ty 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
Party is a Corporation. give name and street address of the Registered Agent:
nn'hard, P'et clant ion@ twariidin3cornparry.00rn
Name of Registered Agent E-mail Address
2125 Pine Drive 2125 Pine Drive
Current Mailing Address Current Street Address
Raleigh, NC 27608 Ra:eigh. NC. 27608
City State Zip City State Zip
Telephone 918 21'�'' 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_
Jon H. Ware President
Type or pri name
A I Trtle or Authority
q/13 .)62
Signature Date `
------ (1
1, /Lrs;vPrtc-4 -----
64iecA . a Notary Public of the County of 72v lPtti)
State of North Carolina, hereby certify that t1-Q A /4/4 ZJ) 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 5641 r#M,!yL 20 2
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