NCC221907_FRO Submitted_20220519

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LAND DISTURBING ACTIVITY
Under the conditions set forth by t U)'15 LD F d Review Fer o
The New Hanover County 1
Soil Erosion and Sedimentation Control Ordinance Dated J 2ate Pd (013
Engineering Department
Applicant or Applicant's Agent: STW Properties, LLC
Mailing Address: 2990 Bethesda Place, Suite 604C Telephone Number:
336-972-3345 Fax Number:
Winston Salem, NC 27103 Email Address: steve aowilliamsdevelopmentgroup.com
Total Acres of Land Disturbance: 2.2 Purpose of Development: residential
Description of Land Disturbance: site work for utilities and access drive
Address of Land Disturbance 3050 Heide Drive
Latitude: N 34.216339 Longitude: W -77.870327
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: STW Properties, LLC _ _ Name: - STW Properties, LLC
Address: 2990 Bethesda Place, Suite 604C Address: 2990 Bethesda Place, Suite 604C
City/State: Winston Salem. NC
Zip Code: 27103
Telephone Number: 336-972-3345 _
Email: sieve@' williamsdevelopmenlgroup.com FaxNumber
City/State: Winston-Salem, NC
_Zip Code: -27103
Location of deed(s) or instrument(s): County: New Hanover
Telephone Number: 336-972-3345
Email: [e-mail] FaxNumber:
Book: 6241 Page: 666 _
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: f `{ t/ Name Stephen Williams Title Member Manager
Signature.�� -
I, o1� _ a Notary Public of the County of State of
North Carolina, hereby certify that , _,-P�. I %1��t'/ ! f _ _ 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 Z Y day of _, 20 L _
Notary# �1 ""'�y commission expires415—
SEAL
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Permission to Enter on Land .o ft13U%is
I certify that I am authorized to grant a y`'
the land in question in connection related to
JM i
,permission to the Erosion Control Inspector and his agents to enter on
application.
Application Signature and Date
PLEASE COMPLETE ALI, PORTIONS OF APPLICATION