NCC232637_FRO Submitted (2)_20230831

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s) may be listed as the financially responsible party(ies).
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Company Name E-mail Address
2625 Charles Blvd
Current Mailing Address Current Street Address
Greenville, NC 27858
City State Zip City State Zip
Phone: Office# 252-321-5334 Mobile#
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Will Kuhn [e-mail]
Name of Registered Agent E-mail Address
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Current Mailing Address Current Street Address
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City / State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact (if Registered Agent is a company)
(b) if the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)