NCC220621_FRO Submitted_20220204

APPLICATION FOR PERMIT FOR A File #
LAND DISTURBING ACTIVITY
Under the conditions set forth by LD Fee Review Fee
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: CSD Engineering
Mailing Address: PO BOX 4041 Telephone Number: 910-791-4441 Fax Number: 910-791-1501
Wilmington NC 28406 Email Address: [e-mail]
Total Acres of Land Disturbance: 5,44 purpose of Development: Apartment Complex
Description of Land Disturbance: Land grading for new drive aisles, parking lots, buildings and roadway improvements
Address of Land Disturbance 3804 Market Street Latitude: 34D14'25" Longitude:-77D53'41"
Land owner(s) of record:
Name: PBW Holdings, LLC
Address:
City/State:
Zip Code:
STATEMENT OF FINANCIAL RESPONSIBILITY
Person or firm(s) financially responsible for the
land disturbing activity. If not a North Carolina
resident, you MUST have a N.C. agent. (List Below)
Name: _PBW Holdings, LLC
18 Palmetto Drive Address: 18 Palmetto Drive
Wrightsville Beach, NC City/State: Wrightsville Beach, NC
28480 Zip Code: 28480
Telephone Number: 910-443-0746
b d ' b 'Id
Telephone Number: 910-443-0746
Emailspetnno@p c esign ui .com FaxNumber Email: [e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 6294 Page: 2221
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: Name David Spetrino Jr
Signature
Title Executive Manager
I,-e�c.ec. E • Seyl&js ' a Notary Public of the County of New t-Laospe/ State of
North Carolina, hereby certify that 6aou ,d A • ��c r'�� �ti appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness z hand notary seal, this -7 day of �w+iz.e i , 20 a 1
NotaryMy commission expires 10'a
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SEAL NOyu' ;_
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Permission to Enter a d 1 C y ���
I certify that I am authon'e'�i'gt1�o in fact grant permission to the Erosion Control Inspector and his agents to enter on
the land in question in connec dtiIMM d to this permit application.
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION