NCC220488_FRO Submitted_20220216

JCN
Durham City/County (Office use only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
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.
I Of
1. Project name: Shoccoree Residential — Phase 11
2. Road location of land -disturbing activity:--4115 Berini Dr., 3941 Shoccoree Dr., Durham, NC, 27705
Tax Map - Block - Parcel: Parcel IDs: 175212 175209 PINS: 0813-03-11-1497 0813-03-10-7250
3. Square footage of land to be disturbed or uncovered: 1,959,421 SF (44.98 AC_
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Beazer Homes, LLC
Name
1000 Abernathy Road Suite 260
Address
Atlanta GA 30328
City State Zip
_925-683-0415 Michael. Snoberger@b azer.com
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.
Beazer Homes, LLC
Name
801 Corporate Center Dr
Street Address
Raleigh NC 27607
City State Zip
925-683-0415 Michael. Snoberer beazer.com
Telephone Fax 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.
201 E. Main St, 511 Floor, Durham, N.C. 27701 • [phone] * Fax [phone]
www.co.durham.nc.us/ceng

a Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
q ze tz-
Name
6--A
Street A ress
�e
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 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.
- /0?/'-'Id /C2) '07 1�Aow' f S' n 0 (a at-);. e -f—
Date Type or Print Name
C) <
Telephone Fax Title or A ority
/71? -5
Email Signature
Business Applicant (Provide corporate resolution on signatory authority)
( t,A , a Notary Public of the County of
State of &Cf avj) f l QA_ hereby certify that too Dey-q le'
personally came before me this day and acknowledged that he is O/VG/
of� eo\,Jq e, N)mes.,LL-(- and acknowledged, on behalf of
at-44 A-- J.
r
Witness my hand and oIcan
comm. EY.P'
My commission expirjs 1 07-09-2023
HE
Individual Applicant
1,
the due execution of the foregoing instrument.
svq day of 20
A
Notary
ot ic
20
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
My commission expires
90
day of
Notary Public
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
go

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.
f 1 Q a? 1 Michael Snoberger
Date Type or Print Name
Business Landowner (Provide corporate resolution on_sianatory authori
a Notary Public of the County of
State of V 1 Caro (110 C , hereby certify that M i C k a `E'. I <J ,,\)v b Ci
personally came before me this day and acknowledged that he is VP_ Lak3c _beue -C1�?/7'110A)
of {=� C'Ct r �`t and acknowledged, on behalf of A 140j' f �.5,
xox,����_,'the due execution of the foregoing instrument.
011
ti
Witness my hand and ` " ' y day of e6 20
a, 0 cornA1. ex)) Notary ublic
My commission expj,* s 2023 20
Cq U
Individual Landowner MIS
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,
My commission expires
SE-03
Rol
day of 20
Notary Public
Rev.07/06