NCC222088_FRO Submitted_20220623

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: McKee Homes LLC
Mailing Address: 4208 Six Forks Road, Suite 610, Raleigh NC 27609
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Telephone Number: 910-475-7100
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File #�o
LD Fee 1_. k Review FeeAtb-
Date Pd Date Pd
Fax Number: n/a
Email Address: [e-mail]
Total Acres of Land Disturbance: 2.2 Acres Purpose of Development: Residential Town Homes
Description of Land Disturbance: Transfer of permit GP #17-06
Address of Land Disturbance 6019 North Bend Road for Anchors Bend Townhomes Latitude: 34.26283 Longitude: -77.78745
Land owner(s) of record:
Name: McKee Homes LLC
Address: 4208 Six Forks Road, Suite 810
City/State: Raleigh, NC
Zip Code: 27609
Telephone Number: 910 475-7100
Email: Jbuckwalteramckeehomesnc.com FaxNumber Na
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: McKee Homes LLC
Address: 4208 Six Forks Road, Suite 1510
City/State: Raleigh, NC
Zip Code: 27609
Telephone Number: 910-475-7100
Email: [e-mail] FaxNumber: n/a
Location of deed(s) or instrument(s): County: New Hanover County
Book: Attached page: Attached
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: 4, zA 7.0 22 t Nam �f�;Y i u'� �d, rti c1. Z' -_• _ Title w �.
Signature �'bj
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I, , `+—Ld,r . _r-) r . a Notary Public of the County of jV�k_-P_ _ State of
North Carolina, hereby certify that PaMC/ ei ritc. - appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
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Witness my hand and notary seal, this S day of , 20 ���.�`'`�O� a►Vy�''%,,,
Notary �-s` �~� My commission expires $lZo� Z#��' '.%J��
SEAL
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Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permissio to theroi�tnitr�li�ctor ael his ag8lttsult►nter on
the land in question in connectio s related to this permit application. LL
Application Signature and Date
PLEASE COMPLETE ALL
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