NCC230049_FRO Submitted_20230109

DURHAM
COUNTY
0
i881
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: 751 South Phase 1 C & 2 - . rL of-�5 158 — 1 7q
2. Road location of land -disturbing activity: See Attachment
Tax Map - Block - Parcel: See Attachment
(Lat. 35-52-43 N Long. 78-57-20 W)
PIN: f '-aL M /.Uf +
Square footage of land to be disturbed or uncovered: l0 r-e-
4. List below the landowner of record. Each landowner must complete item 8.
(If there are multiple owners, please list on a separate page):
NVR, Inc.
Name
5734 Trinity Road, Suite 200
Address
Raleigh NC 27606
City
987-1946 [phone] 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.
NVR, Inc.
Name
5734 Trinity Road, Suite 200
Street Address
NC 27607
City State
[phone] [phone]
Telephone
Fax
Email
. ee
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,
r 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., I" Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www,dconc.gov/index.aspx?page=180

b. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
Corporate Creations Network, Inc. (Registered Agent for NVR, Inc.)
Name
15720 Brixham Hill Avenue #300
Street Address
Charlotte NC 28277-4784
City State Zip
[phone]
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 S 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.
-Z I _ Zz
wIhY-�ti-e.�-
Date T e or Print Name
Telephone Fax Title uthori % },
Email
Business Applicant (Provide corporate resolution on signatory authority) L
I, IV �La I V) e 5, Lela i�S , a Notary Public of the County of TO k ins 1G opl
State of V*k C4,irQjjjjkX hereby certify that __ I [x,Tf k) ! O h L, r
personally came before me this day and acknowledged that he is _ D l V IS t 0�1 M oAn'2�0.e�
of M V 1Z , =N (; , and acknowledged, on behalf of _N V 9, _0 t
the due execution of the foregoing instrument.
Witness my hand and official seal, this f�� day of ,_T) ,C- Ct441,Lt 1 _, 20 7-7-
old tart' I
My commission expires 17 , 20p23 .
Individual Applicant
1,
State
a Notary Public of the County of
hereby certify that
NADINE S. LEWIS
NOTARY PUBLIC
NORTH CAROLINA
W COMMISSION EXPIRES 1017023
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
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
20

Provide a Notarized Item S for each landowner listed in Item 4.
S. 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 S.
Date Type or Print Name
Telephone _ Fax Titl �utho '
Email
Business Landowner f rovide corporate resolution on simiatory authori
I, IV Cat '`l I irl eL, e, CS a Notary Public of the County of o vl S +U P1
State of ' ,_ _*�, hereby certify that M ; Vt r
personally came before me this day and acknowledged that he is ��/ j ,5
of 1 V V y T _ and acknowledged, on behalf of V A , Mac
, the due execution of the foregoing instrument.
Witness my hand and official seal, this t day of 20
Notary Public
My commission expires 20 c2_3 .---
NADINE S. LEWIS
*�a*�***�**:a�x*x*�*�*��*•*�*:*****a**s*r*a**t*�t**�*�****�**�**s*�*:�+*****.***s�*���*e�**s�*��:z��l���ZaP��l+�t'*****��t��
JOHNSTON COUNTY
Individual Landowner NORTH CAROLINA
MY COMMISSION EXPIRES 10f!r=
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 20
day of 20
Notary Public
SE-03
Rev. 10/13