NCC232423_FRO Submitted_20230811

D U R H A Durham City/County (Orate Use Only)
COUNT Sedimentation and Erosion Control JCN
•
NC FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH 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 permitter 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: Mica Ridge
2. Road location of land-disturbing activity: 1516 South Mineral Springs Rd,Durham NC 27703
Tax Map-Block-Parcel: PIN:4g59-72-6t-tai4 nee nimmed for eddiOonalTtt51
3. Square footage of land to be disturbed or uncovered: 76.00 acres(3,310,560 SF)
4. List below the landowner of record.Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
Name
Address
City State 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.
Robert Smart.Division President,Lennar Carolinas.LLC
Name
1100 Perimeter Park Drive,Suite 112
Street Address
Morrisville NC 27560
City State Zip
[phone] robert.smart(a,lennar.com
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'a Floor,Durham,N.C.27701•[phone]•Fax[phone]
www.cu.durham.nc.us/ceng

• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
6. For business applicants,list below the North Caroline registered agent for the financially responsible entity:
Lennar Carolinas,LLC
Name
1100 Perimeter Park Drive,Suite 112
Street Address
Morrisville NC 27560
City State Zip
919-465-5925 robert.smart(Mlennar.com
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.
rI l c 12 U7- Robert Smart
Date Type or Print Name
Telephone
65-5900 Tile P sriy �� _
Telephone Fax Title u rity Q(^�'ih{��•
_robert.smartnJennar.com
Email Sign tore
Busi'n//es,s.Applicant(Provide corporate resolution on signatory authority) /
h t�rat �'1202C.1I ,a Notary Public of the County
of V`-'a'14-A--
State
of �0`4�Ca/-d1M:e( hereby certify that �heit-Crna/4
person/ally-came beforer me this day and acknowledged that he is I� f._17t-$/Q.0
of `—^ + Card M4S((C and acknowledged,on behalf of LLht.11a.✓ (.a (MQS LLL
the due execution of the foregoing instrument. �/
Witness my hand and official seal,this S day of /r L ..//4{/My�./(�M�,,.��p�{''/"/q�"20 PS
'J Notary Public fta
My commission expires 1 -ZUL S 20 .
Individual Applicant
I, 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
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,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 Type or Print Name
Telephone Fax Title or Authority
Email Signature
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Business Landowner(Provide corporate resolution on signatory authority)
a Notary Public of the County of
State of hereby certify that
personally came before me this day and acknowledged that he is
of and acknowledged,on behalf of
the due execution of the foregoing instrument.
Witness my hand and official seal,this day of 20
Notary Public
My commission expires 20_
Individual Landowner
I, 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.07N6