NCC231903_FRO Submitted_20230620

vs1 Y.4, APPLICATION FOR PERMIT FOR A File#
�� "*PA LAND DISTURBING ACTIVITY
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`4'' > Under the conditions set forth by LD Fee Review Fee
- ° The New Hanover County
' A2 Soil Erosion and Sedimentation Control Ordinance
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Engineering Department
Applicant or Applicant's Agent: Libby Shelton,Vice-President
Mailing Address: 131 Racine Drive, Suite 201 Telephone Number: 843-709-0752 Fax Number:
Wilmington, NC 28403 Email [e-mail]
Total Acres of Land Disturbance: 77.19 Purpose of Development: Residential
Description of Land Disturbance: 163 single family lot and 59 townhome residential subdivision.
Address of Land Disturbance 6010 Sidbury Road Latitude:34.33(34°19'45.876"N)Longitude:-77.85(77°51'2.304"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: DR Horton Inc Name: Libby Shelton
Address: 131 Racine Drive, Suite 201 Address: 131 Racine Drive, Suite 201
City/State: Wilmington, NC City/State: Wilmington, NC
Zip Code: 28403 Zip Code: 28403
Telephone Number: 843-709-0752 Telephone Number: 843-709-0752
Email: [e-mail] FaxNumber [e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 6540 page: 2864
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 co ected information should there be//any change i the in o mpati�on provided herein. I
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Date: ) 19 e UU V[� t e I
Signature u.,t toki
I, !A J 1-l_A,J N 11 a Notary Public of the County of N et-3 t4 A,w v a: . State of
North Carolina,hereby certify that L i&li`i S l.-t%L-To 0 appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my han and notary seal, this ab T .5Dit 14 day of JE. ,20Z.- .
Notary ory "1110 0 My commission expires OSII740015 .
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SEAL '1�P F/?)-• '
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Permission to Enter on L ��
I certify that I am authorized' iitpt and Wct grant permission to the Erosion Control Inspector and his agents to enter on
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the land in "on n co nectiorf4ro►p �tgotis permit application.
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Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION