NCC233272_FRO Submitted_20231102

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
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.23-366
Complete Application Received date
Application/N01
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 Walkers Station—Units 25-50
Site Street Address Walker Drive
Site City Wilson
Site County Wilson
Site State NC
Site Zip Code 27893
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 Fall 2023
Total Acres of
Disturbance 2.06
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 [e-mail] **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

r
WILSON
NORTH CAROLINA
(#)ACRES TO BE DISTURBED 2.06 X$150.00/ACRE=$309.00
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.)
9/7/0)Z'3
Dote
Vice President of Land Development
Title or Author!
Sig e
Raymond Rinker
Type or Print Name
1A(tl 4 j i-ka a NotaryPublic of the Countyof VJIJti State of North Carolina
hereby certifi s
( c,tit Iktti4" personally appeared before me this day and under oath acknowledged that the
above for was executed by him. �j �f(y
Sef1041(
Witness my hand and no ry s al,th' l day of_ W Z3
(Notary Public)_
My commission expires `I tAf wMARY HILL HEROLD
NOTARY PUBLIC
WAKE COUNTY, N.C.
My Commission Expires 9-24-2026.