NCC223273_FRO Submitted_20220921

- APPLICATION FOR PERMIT FOR A File #
LAND DISTURBING ACTIVITY
Under the conditions set forth by LD Fee Review Fee
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: Clayton Properties Group, Inc.
Mailing Address: 211 Racine Drive, Suite 101 Telephone Number: 865-380-3000 Fax Number:
Wilmington, NC 28403 Email Address: [e-mail]
Total Acres of Land Disturbance: 10.5 acres purpose of Development: single family residential subdivision
Description of Land Disturbance: clear and grade area for subdivision development
Address of Land Disturbance 311 Hooker Road Latitude:34 13' 29" Longitude: 77 51' 09" _
Land owner(s) of record:
Name: Clayton Properties Group, Inc.
Address: 441 Western Lane
City/State
Irmo, SC
Zip Code: 29063
STATEMENT OF FINANCIAL RESPONSIBILITY
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, LLC
Address: '211 Racine Drive, Suite 101
City/State: Wilmington, NC
Zip Code: 28403
Telephone Number: 865-380-3000 Telephone Number: 865-380-3000
Email: [e-mail] FaxNumber Email: [e-mail] FaxNumber: _
Location of deed(s) or instrument(s): County: New Hanover County Book: 6522 page. 1530
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: `S Z'
Signature
Name Scott Bowser
Title Assistant Secreta
a Notary Public of the County of State of
North Carolina, hereby certify that C)1ir _ appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my -hand and, notary , this day of it/ta 20 .
Notary _ My commission expires ' Z �` 2, Ll
SEAL
NotorY Public _
Permission to Enter on Land
New Hanover County
I certify that I am authorized to granta /i1� in fact r `t`��rmission to the Erosion Control Inspector and his agents to enter on
the lance din question in connection related t�b�,d�phcation.
App
f 22
COMPLETE ALL PORTIONS OF APPLICATION