NCC223935_FRO Submitted_20221123

Durham City/County
Sedimentation and Erosion Control
JCN
(Office Use Only)
I� FINANCIAL RESPONSIBILITYIOWNERSHIP 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:
Pineview Glen Townhomes
2. Road location of land -disturbing activity: 2211 Page Road
Tax ;Map - Block - Parcel:
224590
3. Square footage of land to be disturbed or uncovered:
PIN: 0759-62-06-9587
24 5,7 10 sf or 5.64 acres
4. List below the landowner of record. Each landowner must complete Item S.
(Ifthere are multiple owners, please list on a separate page):
SAB Page, LLC
Name
5310 NC Highway 55, Suite 101
Address
Durham NC 27713
City State Z i p
[phone] [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.
5AB Page, LLC
Name
5310 NC Highway 55, Suite 101
Street Address
Durham NC 27713
City State Zip
[phone] [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.
■ Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar
days.
201 E. Main St, 5" Floor, Durham, N.C. 27701 ■ [phone] • Fax [phone]
www.co.durham.ne. us/ccng

■ 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:
Bruce Knott, Manager
Name
5310 NC Highway 55, Suite 101
Street Address
Durham NC 27713
City State Z i p
[phone] [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.
ZZ Bruce Knott,
Date ' r Type or Print Name
(919) 201-730B Manager
Telephone Fax e--) Title orluthprity
.00m
Email
Signature
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Business Applicant (Provide corporate resolution on signatory authority)
[, • allotary Public of the County of i,x-harm
State of Dior+'% C&tr ,n&_ , hereby certify that 'Brwee W • Kvtoit-
personally came before me this day and acknowledged that he is ex-
of fAl Je LLCe and acknowledged, on behalf of SPI& Qge-. LUL-
the due execution of the foregoing instrument.
Witness my hand and official seal, this 1 «1r► day of 20
Notary Public
My commission expires L 6 &p ex- 4 , 20g&j -. Dutbam County, North Carolina
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Notary Public
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Individual Applicant CoMrN$Sjon Expires 11lt)412024
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 day of 20
My commission expires
20
Notary Public
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE

Provide a Notarized Item 8 for each landowner listed in Item 4.
8. Land Owner Consent. As a landowner, 1 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.
Date
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Type or Print Name
Telenhone Fax Title or A
Email
Signature
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Business Landowner (Provide corporate resolution on signatory authority)
1. Pe arit►— -1 , Fo-br icx*eve-- , a rotary Public of the County of
State ofcm&t1a- hereby certify that yce W , V.,rtintk
personally came before me this day and acknowledged that he is �� _
of "Ap�' 1P&Ae- LLB and acknowledged. on behalf of S1KI6 'P0'Af-' U-C-/
, the due execution of the foregoing instrument.
Witness my hand and official seal, this 11`I'� day of . 2oaa,
.ram
Notary Public
My commission expires ►4 20' '± - Durham County, North Carolina
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beanne P.Fabricatore
Individual Landowner
Commission Expires 1114412024
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 day of .20
Notary Public
My commission expires 20
SE-03 Rev.07146