NCC243040_FRO Submitted_20241011

ROCKY MOUNT
PUBLIC WORKS
TnE CEN1fR O➢It Att
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
City of Rocky Mount. (Please return to [e-mail]).
Part A.
1. Project Name Raper Drive Subdivision
2. Location of land-disturbing activity: County Nash City Rocky Mount
Street Address Raper Drive Latitude 35 . 984 Longitude-7 7 . 827
3. Approximate date land-disturbing activity will begin: January 2025
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site burrow&waste areas): 22 . 64
6. Amount of fee enclosed: $ 2 t 4 50 . 0 0 . The application fee of $250.00 for the first acre
and $100.00 per each additional acre (rounded up to the next acre) is assessed. (Example: For an 8.3
disturbed acreage project, the fee is$1,050).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Marvin Shearin E-mail Address marvinshearin@hotmail . com
Phone: Office# 252-904-0383 Mobile#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Red Oak Farms Development, LLC
Name Phone: Office# Mobile#
5088 Oak Level Raod 5088 Oak Level Raod
Current Mailing Address Current Street Address
Rocky Mount, NC 27804 Rocky Mount, NC 27804
City State Zip City State Zip
10. Deed Book No. 3284 Page No. 4 8 5 Provide a copy of the most current deed.
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).

Red Oak Farms Development, LLC marvinshearin@hotmail . com
Company Name E-mail Address
5088 Oak Level Raod 5088 Oak Level Raod
Current Mailing Address Current Street Address
Rocky Mount, NC 27804 Rocky Mount, NC 27804
City State Zip City State Zip
Phone: Office# 2 5 2—9 0 4—0 3 8 3 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 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# Cell#
Name of individual to contact, if Registered Agent is a company:
(b) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give the name and street address of the Registered Agent:
Marvin Shearin marvinshearin@hotmail . com
Name of Registered Agent E-mail Address
5088 Oak Level Raod 5088 Oak Level Raod
Current Mailing Address Current Street Address
Rocky Mount, NC 27804 Rocky Mount, NC 27804
City State Zip City State Zip
Phone: Office# 252-904-0383 Cell#
Name of individual to contact, if Registered Agent is a company: Marvin Shearin
(c) If the Financially Responsible Party is engaging in business under an assumed name, give name
under which the company is Doing Business As (DBA). If the Financially Responsible Party is an
individual, General Partnership, or other company not registered and doing business under an assumed
name, attach a copy of the Certificate of Assumed Name.
Company DBA Name

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.
Marvin Shar . Manager
pe'or r. f n- ►- Title or Authority
Aar 4?), /. - .2c- V.
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7ur= Date
I, T. !Ltu v VJgrv_9 A , a Notary Public of the County of k w�.�
State of North Carolina, hereby certify that MAvvty 51,•-€ - ;. .A 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 13 day of ¢.1-3 ..w��e✓ , 20 Z 4
KEVIN VARNELL
J. try Public
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Worn Carolina
Edgecombe County Noty
My commission expires 3 /(8( 'Z8