NCC220970_FRO Submitted_20220314

No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. Gulls Landing Subdivision - Phase 1
1. Project Name
Brunswick City or Townshi Sunset Beach
2. Location of land -disturbing activity: County Y p
Highway/Street
Clubhouse Rd. Latitude 33.90 Longitude-78.52
3. Approximate date land -disturbing activity will commence:
Spring/Summer 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.):
Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 8'0
$00.00 . The application fee of $100.00 per acre
6. Amount of fee enclosed: $ pp
(rounded up to the next acre) is assessed without a ceiling amount (Example: 8.10 ac = $900.00).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed XX
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name
Robert Hill E-mail Address [e-mail]
Telephone [phone] cell # 910-209-4611 Fax # NA
a
Landowner(s) of Record (attach accompanied page to list additional owners):
Sunrise Corporate Development Holdings, LLC 910-579-7778
Name
279 Clubhouse Road
Current Mailing Address
Sunset Beach
NC 28468
City State
10. Deed Book No. 3508
Telephone
Same
Current Street Address
Same
Zip City
Page No.1098
State
NA
Fax Number
M
Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) if the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Sunrise Corporate Development Holdings, LLC [e-mail]
Name E-mail Address
279 Clubhouse Road
Current Mailing Address
Sunset Beach NC 28468
City State Zip
Telephone [phone]
Same
Current Street Address
Same
City
Fax Number NA
State
Zip

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telepho
Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Robert Hill
Type or print me
Signat
--------------------------------------------------------------
Member
Title or Authority
Date
I, % ,'�,��?�d►r , a Notary Public of the County of
State of North Carolina, hereby certify that / !?tom appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness m%y,k and,#,,nd notarial seal, this �d,
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