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HomeMy WebLinkAboutNCC230674_FRO Submitted_20230313NOPTH CAP.OBt;t'.. 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 Ordinance 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 Bartlett Job No. 23-013 Complete Application/NOI Application Received date SIC Code (Primary) 1521 Commercial (30001) =1542, Highway (30005) =1611, Industrial (30002) = 1541, Residential, Single -Family Houses (SFE) = 1521, Residential, other than SFE (30000) = 1522, others = blank Project or Site name Walkers Station — Units 1- 24 Site Street Address Walker Drive Site City Wilson Site County Wilson Site State NC Site Zip Code 27893 Site/Facility Type of Ownership POF Non -Government= POF (default) Government - County = CNG Government - Federal = FDF Government - Municipal = MWD Organization Government - State = STF Approximate Activity Start Date Winter/Spring 2023 Total Acres of Disturbance 1.60 FRO - First Name Raymond **MUST be Financially Responsible Owner Person** FRO -Last Name Rinker **MUST be Financially Responsible Owner Person** FRO - Organization Formal Name Starlight Homes North Carolina, LLC **MUST belong to Financially Responsible Owner** FRO - Email Address Raymond.rinker@astonwoods.com **MUST belong to Financially Responsible Owner** FRO - Mailing Street Address 4025 Lake Boone Trail, Ste. 200 **MUST belong to Financially Responsible Owner** FRO - Mailing Supplemental Location Text N/A **MUST belong to Financially Responsible Owner** FRO - Mailing City Raleigh **MUST belong to Financially Responsible Owner** FRO - Mailing State NC **MUST belong to Financially Responsible Owner** FRO - Mailing Zip Code 27607 **MUST belong to Financially Responsible Owner** Latitude: Decimal Degrees 35.723 Longitude: Decimal Degrees -77.967 Rme NORTH CARO!.(NA (#) ACRES TO BE DISTURBED 1.60 X $150.00 /ACRE= $240.00 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: Raymond Rinker Or 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.) Date Vice President` f Land Dev 10 #ent Title or Authori Signatur ' Raymond Rinker Type or Print Name a Notary Public of the County of i A _XA k< h bcertifies State of North Carolina `� 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 L- 11 day of �� (Notary Public) 7) My commission expires Tom! �tii� ?�1AmbGrA. Pullen NDT'ARY PUBLIC Wake County North Carolina My Commission Expires Feburary 6th, 2026