NCC230880_FRO Submitted_20230330

DURHAM
JCN
COUNTYllurl►an► City/Co►utly (Office Ilse Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILl['X"WOWNERSHIP ]DORM Wn'J1111 n_AND
OWNER 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: Cedae Trace Al>'mrt►nents Extension: Yes or G
2, Road location of laud -disturbing activity: Carr Road Durham
Tax Map - Block - Parcel: 131247, 131246, 131245, 131244, 131249 PIN: 0841-32-30-7129, 0841-32-50-4182, 0841-
32-60-9004, 0841-31-89-5925,0841-31-65-1648
3. Square footage of hall(] to be disturbed or uncovered: 12.05 Acres
4. List below the landowner of record. Each landowner must complelc heal 8.
(If there ► re multiple owners, please list on a separate page):
--- ----- --
Name
702 Oberlin Road Suite 400
Address
Raleigh NC 27605
City State Zip
Telephone
Fax
Email
5. List the person or entity financially responsible for this laud-dishn•bing 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 (lie Land Disturbing
Permit.
Cedar Trace Durham. LLC
Name
631 Dickinson Avenue
Street Address
Greenville NC
27834
City Stale
Zip
252-916-2691
dustillLaNaltnlillsgroup.cona
Telephone Fax
Ennall
The Sedimentation and Pollution Control Act (Act) and the Durhann 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.
201 R,. Main St, 5111 Floor, Durham, N.C. 27701 o [phone] o Fax [phone]
n�ru•.co.d a Eli n w.0 c.us/cent;

G.
Provided adequate ground Cover or ollielwise shdiili%e till 111•Cus 111111 have not been actively grilled Nvilhin 21 Calendar
clays.
Plsut and conduct all land -disturbing activity so as to prevent off site sedinientllion.
For business Applicants, list below file North Corolinn registered ugenl for the financially responsible cnlily:
Cechy 'k('e- yly v►. UG
Name
631 Dickinson Avenuo 400
Steel Address
Greenville NC _
278311
City State
Zip
252-916-2691 _ _---
- _ ---tluslill(a)h1ltill illsgimfp.conl.--
Telcpllone rax
Flimil
7. The above inrormation is true and correct to the ties( of illy lalowledge and belief and Was provided by me while under oath. I
allderslillid 111111 (lie persoll of entity listed on Line 5 obove %rill be: (1) the owner of the Land Disturbing Permit when issued;
(2.) responsible for enstn•ing compliance Willi lite AC( and Ordinance; 01l(1, (3) will be lite only person or entity Willi stnnding to
nppeAl any nelion lakell Or decision nmde. by (he Sedilncntalioll and lirosion Control Office.
02/16/202.3 Dustin'1'. Mills
Dale 'Type or Print Name
252-916-2691 - Member/manager
Telephone FIX 'Title orAulhork �('4
d I.StiillMtailIIIIIINI"rollp.coul - _ ),ti C,�! , tit- ,
Cnulil Signature
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llllslness Annilenul (Provide coipornlc resolution on signatory nulhorit' a44(,,4uunr'pn,
}fin D, W illtft4Vh , a Nointy Public of the County or
2 dip
State Of lolrl(n (,OjDW u� ,hereby eerlify 111111 Dt►61 A '_(; li'V111% �C)
personally come before lite (his (la), and acknowledged Thal he is.— tVlbnnbp, ��1y f Af r ti!
c, 'i
of � f�0.�=( J-\rj+l(,,4 , �,(� au(I lianowle(Igc(I, on bchnifof Phew (A-0 c� Ufa\- cp
_-_---- , (lie (lite execution ofllle foregoing Instrument.
witness my hmul an(I official seal, this 111AA (lay of, Rky- itm) , 20 _
It-410'
Nulm), Public
Yconunission expires Ill , 2.0 OIL.
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Illdividunl Agplicnu4
State of
11 Nolaly Public of the Courtly of
hereby certify that. -
personally appeared before Ale this (talc And under oath acknowledged that the Above. 1'01-111 was excelled by them.
wihiess lily hml(I and ol'licial Neill, Ibis (lay ol'•__ _ 20
My commission expires
Nolary Public.
• 20• -
LAND DISTURBING PE'RiV11TS ARV; N(.)N 'I'RANei1 1;1tAlil,1?

Provide a Notarized Item B fot• eaeli latulowner listed in Item 4,
B. 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.
Date � /I (� nn //�� 'Type Ao� Print Name
� /�
`it l LI "l O� N q lY Id,nnl�o.r / lw
Telephone Fax TitleAutllprily
Ili O i V $ ✓ _V S i �_ _ CD wl �
Eel. Signature —
Business Landowner (Provide corporate resolution on si�naia v authorih
1, ArlAa 7 , a Notary 13t►blic of the County of ibo,Aa en
State of n , hereby certify that a Q ; Ue y-
personally came before me this day and acknowledged that lie is _
of�Q. �„ LC and acknowledged, on behalf of A, L
the clue execution of the foregoing insu•milent.
ihtess my AtIiT7e,,wircs
l seal, this _ clay ot'F (v�ra20 a 3
Notary Pubarolina
Cha
My Commissioc 10, 2024 Notary Public
14 commission , ?0 2LL-
Individual Landowner
I, , a Notary Public of the Counly of
State
hereby certify that
Personally appeared before me this (late and under oath acknowledged that the above form was executed by them.
Witness lily hand and official seal, this (lay of , 20
Notary Public
\4), commission expires 20
` E-0.1
Rev.07/0G