NCC221808_FRO Submitted_20220511

Durham City/County
Sedimentation and Erosion Control
JCN
(Office Use Only)
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.
PLEASE TYPE OR PRINT
1. Project name: Gillings Property
2. Road location of land -disturbing activity: 4110 & 4111 Page Rd. Durham, NC 27560
Tax Map - Block - Parcel: 158116 (Durham Map) PIN: 0757-28-4416
3. Square footage of land to be disturbed or uncovered: 15.61 Acres
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners, please list on a separate page):
Lennar Carolinas, LLC
Name
1100 Perimter Park Dr. Suite 112
Address
Morrisville NC 27560
City State Zip
919-465-5900 [e-mail]
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.
Lennar Carolinas, LLC
Name
1100 Perimeter Park Dr. Suite 112
Street Address
Morrisville NC 27560
City State Zip
919-465-5900 [e-mail]
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.
■ Refer to Section 12.10.413 of the Durham City/County UDO for groundcover time line requirements.
■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
120 E. Parrish Street, Law Bldg., 1" Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.dcone.gov/i ndex.aspx? page=180

6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
Troy George
Name
1100 Perimeter Park Dr. Suite 112
Street Address
Morrisville NC 27560
City State Zip
919-465-5900 [e-mail]
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.
Troy George
Date Type or Print Name
919-465-5900 Division President
Telephone Fax or Authority
[e-mail] ,
Email Si e"
I, ( OVCVt f41 Z -e 1-1 a Notary Public of the County of W cu"
State of � OVJA Ca VQ l ("A A hereby certify that 6
personally came before me this day and acknowledged that he is ' I-V pms I
of `,C k KA VjAr#th*. (,LC— and acknowledged, on behalf of (��{Q✓CQ�Q 1,K45 u-L
, the due execution of the foregoing instrument.
Witness my hand and official seal, this day of4-0,1
biota 4blic
My commission expires '— �% 20 . &4 6J
Individual Applicant
I, , a Notary Public of the County of
State of , hereby certify that
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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
20
day of
Notary Public
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.
Troy George
Date Type or Print Name
919-465-5900 Division President
Telephone Fax Titlr-Zt ority
[e-mail] .
Email
Business Landowner(Providecorporate resolution on signatory authority) ,, ,,\
I, 4� 1 Ve k j&-:C [il a Notary Public of the County of Wak
State of N W1W Cu V01 lh U hereby certify that "fyo\/ 6'� UfGJ
personally came before me this day and acknowledged that he is )f V 1 s`al PAest
of G61t WAK(Q rd U)tA S C -L._ and acknowledged, on behalf of LPit "e' C ayy mas tLC
, the due execution of the foregoing instrument.
Witness my hand and official seal, this day of b >Lovi I , 20 ZZ
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_lN�tiry Public ��H.
My commission expires '—� 20 C�Ka�•N�,.,.�y_ �.�
i NOTARY i
Individual Landowner
PUBLIC =
I, a Notary Public of the County of ��� °•. r �.
State of hereby certify that •������iiG,D U N C� i-01
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 120
My commission expires
FIE
Notary Public
5E-03 Rev. 10113