NCC231773_FRO Submitted_20230608

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKE No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
b an abo
COUNTY sedimentationCountyUnified controlDevelopment plan haveOrdinance been completedefore and this approvedform byand Wake Countyaccept le Departmenter sion ofand
NOR H CA zO N.A Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
1. Project Name Kanne Residence - 13448 Melvin Arnold Road
2. Location of land-disturbing activity: Jurisdiction Wake (Wake Co. or Municipality)
Melvin Arnold Rd -78.92849 35.972799
Highway/Street Latitude _Longitude
3. Approximate date land-disturbing activity will commence: June /July 2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): .45
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Christopher M. Kanne E-mail Address [e-mail]
Telephone NA Cell# 919-669-3631 Fax# NA
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Marquis Homes & Company 919-870-6339 [e-mail]
Name(s) Telephone Fax or E-mail address
8368 Six Forks Road STE 202 Same
Current Mailing Address Current Street Address
Raleigh, NC 27615 Same
City State Zip City State Zip
8. Deed Book No. 19048 Page No. 2423 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
Christopher M. Kanne [e-mail]
Name E-mail Address
1101 New World Circle, Apt 102 Same
Current Mailing Address Current Street Address
Raleigh NC 27615 same
City State Zip City State Zip
Telephone[phone] Fax Number NA

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Christopher M. Kanne Purchaser under contract for porperty
Typ or print name Title or Authority
(A fl'i S-Pk il# PA/-, _
(1/2:7/Z. 3
Signature Date
I, �oh2►..rt.a t'Z.. la..1 La r , a Notary Public of the County of_l..1..)2 kit_
Stateof North Carolina, hereby certify that al\r t s}aSaer P-t t2Y1l1e_ appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 2 1 day of fA‘=.r;, , 20 23
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