NCC222573_FRO Submitted_20220725

Submit to the Water Resources Department, 316 N. Academy St., Cary, NC 27513
Town of Cary
Water Resources Department
Financial Responsibility - Ownership Form
No person may initiate any land disturbing activity covered by the Town of Cary Sedimentation and
Erosion Control Ordinance before completing and filing this form with the Town of Cary Stormwater
Division. Indicate N/A if a question is not applicable.
PROJECT NAME Aventon Kit Creek Apartments (21-DP-1343)
PROJECT LOCATION 7655 Kit Creek Road and 5329 NC Hwy 55
APPROXIMATE DATE OF PROJECT INITIATION May 2022
ACREAGE OF LAND TO BE DISTURBED 12.9 acres
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.)
Aventon Construction North, LLC
Name (Person or Firm)
1201 Edwards Mill Road, Suite 120
Street Address (No PO Box)
Raleigh, NC 27607
City State Zip
984-777-3363
Telephone Number
Fax Number
[e-mail]
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
N/A
Name
Street Address (No PO Box)
City State Zip
Telephone Number
Fax Number
E-Mail Address
TowN of CARY
316 North Academy Street • Cary, NC 27513 • PO Box 8005 • Cary, NC 27512-8005
tel [phone] • fax [phone] xv%vw,townofcary-org

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.
Tom Keady OR
Financially Responsible Person Registered Agent
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.
Tom Keady
Type or P int
Signatupd
CEO of Manager
Title or Authority
4/19/2022
North Carolina
County
I "a Notary Public for
WAY -
County, North Carolina, do
hereby certify that -F� �� �_ `f personally came before me this day and acknowledged
Jthat
he is G5o of Y\ , and acknowledged, on behalf of
the due execution of the foregoing instrument.
Witness my hand and official seal, this the V� day of �)�wV 1, 20 Z� "
CINNAMON FORREST
Notary Public Notary Public - North Carolina
�y Wake County
My commission expires ' ' 1'i�2A �J 20 �Q, My Commission Expires Apr 13, 2026
TOWN of CARY
316 North Academy Street • Cary, NC 27513 • PO Box 8005 • Cary, NC 27512-8005
tel [phone] • fax [phone] • NvwAv.townofcary.org
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