NCC215655_FRO Submitted_20211012

Durham City/County
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSI
WITH LANDOWNER CONSENT FO
JCN
(Office Use Only)
FORM
No person may initiate any land -disturbing activity covered by the Durham City -County Unified Develop eat 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: 3404 Page Road Townhomes
2. Road location of land -disturbing activity: 3404 Page Road
Tax Map - Block - Parcel: 157692 PIN: 0758-03-33-0349
3. Square footage of land to be disturbed or uncovered: 1,089,000 sf (25.00 act
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Capital Properties of Raleigh II. LLC
Name
3724 National Drive, Suite 220
Address
Raleigh NC 27612
City State zip
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.
Capital Properties of Raleigh II, LLC
Name
3724 National Drive, Suite 220
Street Address
Raleigh NC
City State
984-200-5540
Telephone Fax
77612
zip
davidows hen andoa hhomes.us
Email
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.
201 E. Main St, 5t° Floor, Durham, N.C. 27701 ■ [phone] ■ Fax [phone]
www.co.durham.nc.us/ceng

6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
David Stallings
Name
3724 National Drive, Suite 220
Street Address
Raleigh
City
984-200-5540,
Telephone
NC
State
Fax
27612
Zip
[e-mail]
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.
6/22/2020
Date
984-200-5540
Telephone
David a[@shenandoahhomesms
Email
Fax
David Stallings
Type or Print Name
Title or Authority
Signature
Business Applicant (Provide corporate resolution on signatory_ authority)
I,a NotaryPublic of the County of
State of _ �, � hereby certify that i�),,r ,k S!mvl
personally came before me this day and acknowledged that he is r
of ,,;� a Pro�c. r wes Ertl+i �nd acknowledged, on behalf of CAii [�, a + �S QJ �
the due execution of the foregoing instrument.
Witness my hand and official seal, this 21 yk day of -�� , 20 20
Notary Public Jill
Chianne Capes
My commission expires , 20" �;� Notary Public
Franklin County
M commission_x ure
Individual Applicant
I,
State
a Notary Public of the County 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
My commission expires
day of
Notary Public
20
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
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.
6/22/2020
Date
984-200-5540
Telephone
[e-mail]
Email
Fax
David Stallings_
Type or Print Name
President
Title or Authority
Signature
###################################################################################################################################
Business Landowner {Provide corporate resolution on signatory authority]
I, �•�; [ , a Notary Public of the County of
State of hereby certify that
personally came before me this day and acknowledged that he is
of (�� [�. /{ i t $ W— l�rr�alc nawledged, on behalf of,
Witness my hand and official seal, this
the due execution of the foregoing instrument.
22� day of ,-
20 2-,(-
Notary Public Notary Pubic
My commission expires i , 20 Franklin County
North Carolina
m fission Ex ices 4 721021
Individual Landowner
I,
State
a Notary Public of the County 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
My commission expires
20
Notary Public
20
5E-03 Rev.07/06