NCC243260_FRO Submitted_20241023

JCN
Durham City/County (Office Use Only)
Sedimentation and Erosion Control
FINANCIAL • SIB NSI ILITY/ NE S IP FO
WITH LANDOWNER CONSENT FO
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 P' I ,T
1. Project mane: U #T S t Extension: Yes or o
t
2. Road location of land-disturbing activity: 1,,O (( .� "N O,Cl
Tax Map-Block-Parcel: 3 '-t 53 ??
3. Square footage of land to be disturbed or uncovered: '4
4. List below the landowner of record. Each landowner must complete Item S.
(If there are multiple owners,please list on a separate pa a):
ciy v { us•AA 4 ie_o, •1 9'c-1e_\( . u 'r c
Name
Af Jdr ss
P-US-kr 1e)1.in S-C)
City State Zip
`'I -2,3 6a17- Zt, Coves
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.
t ti, ' t -
Name
I
12-0g fails ®-p N1tv ZOl
S et Address
YYCLO isj ( I S'
City State Zip
(41 V tid (orv--
Telephone Fax Email
As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
unities) communication at •±,r-v-,doh OS 1 a) I in b .C.0m
(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,5te Floor,Durham,N.C.27701 a(919)560-0735 a Fax[phone]
www.co.durham.nc.us/ceng

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
C • C X i
Name
kqo a fiv Lo-ttk. 2-0"6
Sk:et Address
V` CTI) J,A r\I c:Qr1 Li>
City State Zip
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 wider 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.
9 eip I 2Za vca 661 i\a '111, IS
Date Type or Pnnt Name
(1) ) 2.420)16 r\a_k S-Mvt-v-n"sC40--/00,r10,v--
Telephone, Fax Ale or Authority
-t-itY1 fit a LA S' Libl/110 int
Email Signature
Business Applicant(Provide corporate resolution on signatory authority)
I, C ,a Notary Public of the County of Cn\Yer
State of ' CA8d) ,hereby certify that
personally came before me this day and acknowledged thahe is )'°‘ c\C\Soec01,„
‘)),('
oft \\ and acknowledged,on behalf of ,
the due execution of the foregoing instrument.
Witd . and officio seal,this )(c) day of(
NOTARY PUBLIC
Johnston County ,20
North Carolina -y Public
My Comm E Inssi ,tAr L 20 a__,z), .
************************************************************t****************************A***********r4***************************
Individual Applicant
,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
Jason Rivenbark
Date Type or Print Name
919-309-5291 VP, Real Estate Investm'ents &Development
Telephone Fax Title or.°Autborit
[e-mail]_ ,_ ,
Email Si‘nature
Business Landowner(Provide col(}orate resolution on sipnatoi vauthorit,
I Christy Messer ,a Notary Public of the County of Lee
State of North Carolina ,hereby certify that Jason Rivenbark
personally came before me this day and acknowledged that he is VP,Real Estate Investments &Development
Forestar(USA) Real Estate GroupInc Forestar(USA) Real Estate Group,Inc.
of abd acknowledged,on behalf of
$c.?
tuuuuiurthe due execution of the foregoing instrument, 4 MFSSii�,��
Witness my hand and official seal,this 17th day of September e��p2TARY ��'''
8/12 Notary Publ �G
My commission expires 20
28 PUBL
''(M�err�iunntHtN�O``
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