NCC250125_FRO Submitted_20250116

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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: Terraces of West Cary Townhomes
PROJECT DEVELOPMENT PLAN #: 23-DP-6455
PROJECT LOCATION:
0735-61-9230
Property Tax 1Qtt/PIN
3851 NC 55 HWY,CARY, NC 27519. 3761 NC 55 HWY.CARY, NC 27519. 3753 NC 55 HWY ,CARY, NC 27519.
Street Address
APPROXIMATE DATE OF PROJECT INITIATION: 1/09/2025
ACREAGE OF LAND TO BE DISTURBED: 9.97 acres
APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2
of the Financial Responsibility/Ownership (FR/O) Form.)
Terraces at West Cary Fund, 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.)
Terraces at West Cary Fund, LLC.
Name(Person or Firm)
105 KILMAYNE DRIVE, SUITE C
Street Address(No PO Box)
CARY, NC, 27511
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

(910) 578- 8282
Telephone Number
N/A
Fax Number
[e-mail]
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.)
Gaurang Gala
Name
105 KILMAYNE DRIVE, SUITE C
Street Address(No PO Box)
CARY, NC, 27511
City State Zip
(910) 578- 8282
Telephone Number
N/A
Fax Number
[e-mail]
E-Mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation. Please indicate your preference below.
OR Gaurang Gala
Financially Responsible Person Registered Agent
Section 3
LANDOWNER OF RECORD:
Gala Investments, LLC
Name(Person or Firm)
0735-61-9230
Property Tax ID#/PIN
3851 NC 55 HWY. 3761 NC 55 HWY. 3753 NC 55 HWY.
Street Address(No PO Box)
CARY, NC 27519.
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.
(Gala Investments. LL C C 40
Name Title or Authority
1 - 6- 75_
Signature Date
[e-mail]
� 910-578-8282
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.)
1Gaurang Gala [ G A
Type or Print Name Title or Authority
/ -6 -25
Si nature
g Date
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State of North Carolina, hereby certifies that (�—C1l,`C'(f,V1O C7CL ICk
personally appeared before me this day and under oath acknowledged that the above form was
executed by him/her.
Witness my hand and notarial seal, this day of r,!() , PS5
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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