NCC222366_FRO Submitted_20220630

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APPLICATION FOR PERMIT FOR A
LAND DISTURBING ACTIVITY
Under the conditions set forth by
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Engineering Department
Applicant or Applicant's Agent: Norris & Tunstall Consulting Engineers, P.C. / J. Phillip Norris P.E.
Mailing Address: 1429 Ash -Little River Road
Ash, NC 28420
File #
LD Fee Review Fee
Date Pd Date Pd
Telephone Number: 910-287-5900 Fa
Email Address: [e-mail]
Number: 910-287-5902
Total Acres of Land Disturbance: 0.45 Purpose of Development: Road Construction
Description of Land Disturbance: Placement of approximately 2,000 CY of fill material for a road crossing.
Address of Land Disturbance 7260 River Road Access Road Latitude: 340 05' 53" Longitude:-770 55' 18"
STATEMENT OF FINANCIAL RESPONSIBILITY
Land owner(s) of record: Person or firm(s) financially responsible for the
land disturbing activity. If not a North Carolina
Nathan S. Sanders & Judia B. Sanders resident, you MUST have a N.C. a�ent. (List Below)
A Name: Name: la 441 r_r. S. Se •.de%.S ,I- Zlc cdi e-_ Q . :L.,�
Address: 006, 6 o x 31(,7 Address: P. 0 . Sb X 3/ 6 7
City/State: L.)� /r+,; na ;-erg, hdC_ City/State: L): 1•v%i r.g . , /V
Zip Code: a$ y 0 0 Zip Code: a'916 So
Telephone Number: Telephone Number:
Email: Sc neo k Drv.ca@ FaxNumber NA Email: Sa^c6 ho►•.-e a FaxNumber:
Sc#%co a -e,�. ems+ Newllanover Se'Cako�-a� Cep— 1756/3143 41/347
Location of deed(s) or instrument(s): County: Book. Page:
The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath.
(This form must be signed by the financially responsible person if an individual and by an officer, director, partner, attorney -in -
fact, or other person of authority to execute instruments for the financially responsible person if not an individual.) I agree to
provide corrected information should there be any change in the information provided herein.
Date: 02 'a`% AN,titxre Nam_ S ..Sr- de _� Title Q
Signature 4L44 aNtcz-w_�_
;oA ao 'i,
I,At, a Notary Publi of the County of State of
North Carolina, hereby certify that �__ �t—_�, appeared personally before me this day and
being duly sworn acknowledged that the above form was executed eye# vd,+o. '�b 50VvA.�-5
Witness my hand and notary seal, this�14 Wd ', _ 20 ].24-
Notary •• , P F CVv commiss�es U �'W (AxAl
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SEAL CZ7USLIC
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Permission to Enter on Land ��'l�CouN(; +•` C ' p
I certify that I am authorized to grant and do if 'f4WWiggr�Ht permission to the Erosion Control Inspector and i`�ft pn s "Ifir AC"
;kT;t;ion related to this permit application. %,�/�; ••.....••''•
'• kCOUN�y,.••.
Date ' � ARIMONS
PLEASE MPLETE ALL O LI ATION