NCC232810_FRO Submitted_20230918

DURHAM JCN
COUNTY Durham City/County
0 3E
Sedimentation and Erosion Control (Office Use Only)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
r" 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:Nichols Village
Extension: Yes or 0
2. Road location of land-disturbing activity:Doc Nichols Road
Tax Map-Block-Parcel:PID: 0000193362. 0000224432 PIN:086Q-11-77-2598. 0860-03-20-2929
3. Square footage of land to be disturbed or uncovered:340,090.42 (7.81 AC)
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate pag)e :
Greenwood Homes Raleigh, LLC e e c, /04Z ,' .-
Name
1628 Hidden Leaf Court
Address
Raleigh NC 27606
City State Zip
703.856.7081
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.
Greenwood Homes Raleigh, LLC c/ 44Gj" !A/, Are____...-------
Name
1628 Hidden Leaf Court
Street Address
Raleigh NC 27606
City State Zip
703.856.7081
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,5h Floor,Durham,N.C.27701•[phone]•Fax[phone]
www.co.durham.nc.us/ceng

I 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:
R'RE— I! — H-I StQ.-, L4 / ' wL I► S70_1
Name
200 S u ' rl;}«7 OR 6 ivJ s‘..i i 35—0
Street Address
'LI'e. ,,11 (L '3-) l 3 i
C��,� ��� 6 � LA/i '
State Zip 11 --
5 i. (,SI V1
t,) 0 (`)(dbLCk/ ( O-,
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.
,
Date D c Type or Print Na
Telephone Fax Title or Authori
ar 'e 1.614,Aviria di s, Cam
Email Si ature
%id MIA I
Business Applicant(Provide corporate resolution on signatory authority) /� 1 4 ry
1, S'1/3/2 (moo We ,a Notary Public of the County of / D/etr G d "- o
ry N
p CM N
State of C�!`U r /G i gi
� ,hereby certify that �/ L ��'j>y' � 3 g i N X
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personally came before me this day and acknowledged that he is 6 1/'/O 1 j 1,1 A
of R i2 CP i i-/M 5/e,-ret //4 and acknowledged,on behalf of 2 ii —1— Si evr tt lit. 0 �� .1 E .
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,the due execution of the foregoing instrument. / E
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Witness my hand and official seal,this Jo ' day of it Uf/ ,20
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Notary._ublip
My commission expires /2- Z<p• ,zo--
Individual Applicknt
l( 1, -0Y#144 et �LW ,a Notary Public of the County of PLC
State of L� I4 C 11.0 ,hereby certify that£ Cs G (.,t/&a 1.—
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 0 day of n ,20 04-.)
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Notar ublic A - ,�` ''
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My commission expires r 20 efb i 40 T y VAA
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LAND DISTURBING PERMITS ARE NON-TRANSFERABLE i 1 1
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