NCC243565_FRO Submitted_20241120

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CITY OF GREENSBORO
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity covered by the Sedimentation Pollution Control Act before this form
has been completed and filed with the Sediment and Erosion Control Section of the City of Greensboro. (Please type
or print and,if questions are not applicable,place N/A in the blank).
Part A:
1. Project Name: Whataburger-Greensboro(Wendover Ave)
2. Location of land-disturbing activity: 4409 W Wendover Avenue, Greensboro, NC 27407
3. Approximate date land disturbing activity will be commenced: October 2024
4. Development type: Commercial ✓ Industrial_Institutional_MF residential_SF residential
5. Approximate acreage of land to be disturbed: 1.31
6. Has an erosion and sediment control plan been filed? Yes No
7. Landowner(s)of Record(attach pages to list additional owners):
Wendover SS LLC 336-812-3313 [e-mail]
Name Telephone Email
702 Waycross Drive
Current Mailing Address Current Physical Street Address
Greensboro NC 27410
City State Zip City State Zip
8. Deed County: Guilford Book: 5168 Page: 904
9. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Wesley Williams Telephone: [phone]
E-mail: [e-mail] Other:
Part B:
1. Company(ies) or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive
list of all responsible parties on an attached sheet.)If the company or frmm is a sole proprietorship the name of the owner
or manager may be listed as the financially responsible party.
Whataburger Restaurants, LLC 210-425-9430 [e-mail]
Name Telephone Email
300 Concord Plaza Drive
Current Mailing Address Current Physical Street Address
San Antonio TX 78216
City State Zip City State Zip

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:
SOP® cse,y )o b�.
Corporation Service Companyhin r 800-927-9801 atrt rt3
Name Telephone Email
2626 Glenwood Avenue, Suite 550 same
Current Mailing Address Current Physical Street Address
Raleigh NC 27608
City State Zip City State Zip
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed
name,attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation,
give name and street address of the Registered Agent:
Name Telephone Email
Current Mailing Address Current Physical Street Address
City State Zip City State Zip
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.
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Type or Or-it-dame Title or Authority
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Signature Date
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I, Q {1(00r\ wl A (S a Notary Public of the County of �✓�I�
State of CIO(`{-h (ti f O I,(O, , hereby certify that We 5(et, W, I i teitykS
Personally accepted before me this day and under oath acknowledged that the above form was
executed by owner(s).
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Witness my hand and notarial seal. this J4 kday of IV\ , 20 I�I
My Commission expires 0 57 I Li( c-`1
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