APPLICATION PG 1

NORTH CAROLINA MINING State of North Carolina 1612 Mail Service Center
PERMIT APPLICATION Department of Environmental Quality Raleigh,NC 27699-1612
Division of Energy,Mineral,and Land Resources [phone]
NOTE: It is recommended that you contact the appropriate Regional Office or the Raleigh Central Office for a PRE-
APPLICATION MEETING to discuss your intentions and address any questions.
1. Name of Mine Cameron Pit
County NEW HANOVER COUNTY River Basin CAPE FEAR
Latitude(decimal degrees to four
places) 34.3303
Longitude(decimal degrees to four
places) 78.0045
2. Name of Applicant 421 SAND MINE, LLC
Applicant Contact Bruce Cameron IV Consultant Contact Greg Wayne
Applicant Email [e-mail] Consultant Email [e-mail]
Telephone [phone] Telephone [phone]
Cell Phone Cell Phone
3 Permanent Address for Receipt of
Official Mail** 421 Sand Mine LLC
P.O Box 3649 Wilmington, North Carolina 28406
4. Mine Office Address 5401 Hwy 421
Wilmington, NC 28401
5. Mine Manager John Allen
Mine Manager Email [e-mail]
Telephone Cell Phone [phone]
1 certify that all details contained in this permit application are true and correct to the best of our knowledge.We
fully understand that any willful misrepresentation of facts will be cause for permit revocation.
Signature*** 46", � Date S�Z Zo 43
Print Name I-3Lu'6 6
Title -f'6 's t u
*This will be the name that the mining permit will be issued to and the name that must be indicated on the reclamation bond(security)that
corresponds to this site.
-The Division of Energy,Mineral,and Land Resources must be notified of any changes in the permanent address or telephone number.
—Signature of company officer required.
G.S.74-51 provides that the Department shall grant or deny an application for a permit within 60 days of receipt of a complete
application or,if a public hearing is held,within 30 days following the hearing and the filing of any supplemental information
required by the Department.All questions must be addressed,and all required maps provided before this application can
be considered complete.Attach additional sheets as needed.
Revised September 21, 2021 P a g e d