NCC231218_FRO Submitted_20230427

`�,.-r i+ APPLICATION FOR PERMIT FOR A
LAND DISTURBING ACTIVITY File#
< ' Under the conditions set forth by LD Fee Review Fee
Nip
. The New Hanover County
' �� Soil Erosion and Sedimentation Control Ordinance
,.,„„./ Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: Fly Wilmington, LLC
Mailing Address: 1441 Parkview Circle Unit 303 Telephone Number: 203-571-8821 Fax Number:
Wilmington, NC 28405 Email Address: [e-mail]
Total Acres of Land Disturbance: 1.30 _ Purpose of Development: Commerical
Description of Land Disturbance: Clearing and construction for Indoor Sky dive facility.
Address of Land Disturbance 1441 Eastwood Road Latitude: 34.23(34°13'57.55"N)Longitude:_77.04(77°50'15.96"W)
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
resident,you MUST have a N.C.agent. (List Below)
Name: Oakens Trading Post, LLC-Jason D. Swain Name: Fly wimington,LLC
Address: 1131-b Military Cutoff Road Address: 1441 Parkview Circle Unit 303
City/State: Wilmington, NC City/State: Wilmington, NC
Zip Code: 28405 Zip Code: 28405
Telephone Number: 910-239-5590 Telephone Number: 203-571-8821
1 Email: [e-mail] FaxNumber Email:[e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 6533 page: 1416
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: A' n2_ C.)' _ N:une,D4(.1:'J Bello Title C'LC'i C j Q5'" OA `
Signature mot_ zi7„,6"--_______ _ ,
I, ad m1 k Ma-6.--1a"t\1..5.mmiya., a Notary Public of the County of-a vim✓ State of
North Carolina, hereby certify tharDa,va 5Af S appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notary seal, this'l' _ ay of II^,�C,- ,20 'ZZ_
Notary etetv, 1 My commission expires 9 j 11 £ OTJ
SIMIlie Mabe Fitzsimmons
Notary Public
Brunswick County, NC
Permission to Fiii 'r un 1.4114
I certify that I am authorized to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the land in question in connection related to this permit application.
(---- ___ .ri_Sit —, /4C22 a.
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION