NCC232632_FRO Submitted_20230830

WILSON
Financial Responsibility-Ownership Form
No person may partake in any land disturbing activity within the confines of the City of Wilson Sedimentation and Erosion Control Ordinanc
before completing and filing this form with the City of Wilson Erosion Control Division. (*Indicate N/A if a question is not applicable)
Field Name Description Comments
PROJECT Tracking
number
Complete
Application/NOI
Commercial(30001)=1542,Highway(30005)=1611,Industrial(30002
=1541,Residential,Single Family Houses(SFE)=1521,Residential,
SIC Code(Primary) 1521 other than SFE(30000)=1522,others=blank
Project or Site name Heritage Place—Section Six Phase IV
Site Street Address On Gloucester Dr 500'from Airport Blvd.NW
Site City Wilson
Site County Wilson
Site State NC
Site Zip Code 27896
Non-Government=POF(default)
Government-County =CNG
Government-Federal=FDF
Site/Facility Type of Government-Municipal=MWD
Ownership POF Organization Government-State=STF
Approximate Activity
Start Date August 07,2023
Total Acres of
Disturbance 0.70 ACRES
FRO-First Name Ronald **MUST be Financially Responsible Owner Person**
FRO-Last Name Langley,Jr. **MUST be Financially Responsible Owner Person**
FRO- Organization
Formal Name 0&L Investments,LLC **MUST belong to Financially Responsible Owner**
FRO-eMail Address [e-mail] **MUST belong to Financially Responsible Owner**
FRO-Mailing Street
Address 4602 US Hwy.301 N **MUST belong to Financially Responsible Owner**
FRO-Mailing
Supplemental Location
Text **MUST belong to Financially Responsible Owner**
FRO-Mailing City Elm City **MUST belong to Financially Responsible Owner**
FRO-Mailing State NC **MUST belong to Financially Responsible Owner**
FRO-Mailing Zip Code 27822 **MUST belong to Financially Responsible Owner**
Latitude:Decimal
Degrees 35.7399
Longitude:Decimal
Degrees
-77.9733

•
WILSON
(#)ACRES TO BE DISTURBED 0.70 AC X$150.00/ACRE=$105.00
Person(s)or Firm(s)financially responsible for this land disturbing activity:(If out of state,a registered agent in North Carolina
must be used.)
In case of a violation please list the preferred contact(either the Financially Responsible Person or Registered Agent on the line
below:
Ronald Lee Langley,Jr. Ronnie L.Sutton, PE
Financially Responsible Person Registered Agent
The above information is true and correct to the best of my knowledge and belief and as provided by me while under oath. (This
form must be signed by the Financially Responsible Person if an individual or by an officer,director, partner, and attorney-in-fact,
or other person with authority to execute instruments for the financially responsible person if not an individual.)
07/05/2023
Date
Member
Title or Authority
76f
Signature
Ronald Lee Langley,Jr.
Type or Print Name
Member
Title Date
O f Many): 1,,? a Notary Public of the County of Oa S ,State of North Carolina
hereby certifies
ov,a1A t —Cr' personally appeared before me this day and under oath acknowledged that the
above form was executed by him. —{
Witness my hand and notary seal,this 5�~ day of L.tt tOZ3
`'�
(Notary Public) AZ, l
T.
c)TA�i'� �G'
My commission expires I
,.
`% h C Nam'