NCC241585_FRO Submitted_20240523

T' .vow APPLICATION FOR PERMIT FOR A File#
�y LAND DISTURBING ACTIVITY
z ' r �' Under the conditions set forth by LD Fee Review Fee
z` IAA o
g ,� _ The New Hanover County
,• ,',III -, Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
•4''sTAD L(SHEV,�
Engineering Department
Applicant or Applicant's Agent: Clayton Properties Group, Inc.
Mailing Address: 160 Mine Lake Court, Suite 200 Telephone Number: [phone] Fax Number: N/A
Raleigh, NC 27615 Email Address: [e-mail]
Total Acres of Land Disturbance: 64.3 Purpose of Development: residential subdivision
Description of Land Disturbance: Avenue One- Phase 1: land development for 366-lot subdivision with four ponds
Address of Land Disturbance —5350 Sidbury Road (SR-1336) Latitude: 34.3289 N Longitude: 77.8658 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: Clayton Properties Group, Inc. Name: Clayton Properties Group, Inc.
Address: 160 Mine Lake Court, Suite 200 Address: 160 Mine Lake Court, Suite 200
City/State: Raleigh, NC City/State: Raleigh, NC
Zip Code: 27615 Zip Code: 27615
Telephone Number: [phone] Telephone Number: [phone]
Email: [e-mail] FaxNumber N/A Email: [e-mail] FaxNumber: N/A
Location of deed(s) or instrument(s): County: New Hanover Book: 6615 Page: 2815-2818
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: 2-/1 / 2_
Name �CCAT BOW C(r Title A5s�, SE�-j- c-$-rc�
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Signature < _
I, V Y ley I—V u hA(e_ a Notary Public of the County ofNO—) f k(-?. ,Y State of
North Carolina,hereby certify that S(A' Q- I?c)i--'.CJ appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my.h a notary seal, this 1 day of re-" tvti , 20 2 4 .
Notary My commission expires 0 Li' -
SEAL F '.'
Noteit,Public
=_ Ne�v y®Hover CountyZ
Permission to Enter on lanfl
I certify that I am authoriz � rant and 4 rl ct grant permission to the Erosion Control Inspector and his agents to enter on
the land in question in connec'((49'1140 j1el fli�is permit application.
)
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Applicat ignature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION