NCC231700_FRO Submitted (3)_20230623

`,%,NTY. APPLICATION FOR PERMIT FOR A File#
LAND DISTURBING ACTIVITY
3 Under the conditions set forth
A by LD Fee Review Fee
° The New Hanover County
.1 Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: Pulte Home Company, LLC
Mailing Address: 1225 Crescent Green Drive Suite 250 Telephone Number: 919-795-9347 Fax Number:
Cary NC 27518 Email Address: [e-mail]
Total Acres of Land Disturbance: 0.88 AC Purpose of Development: Residential Subdivision
Description of Land Disturbance: Lots 746,747,748,896,&897
Address of Land Disturbance 4410 River Road Wilmington,NC 28412 Latitude:34 8'24.2"N Longitude:77 55'39.7"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: Pulte Home Company, LLC Name: Pulte Home Company,LLC
Address: 1225 Crescent Green Drive Suite 250 Address: 4136 Passerine Avenue
City/State: Cary, NC City/State: Wilmington,NC
Zip Code: 27518 Zip Code: 28412
Telephone Number: 919-816-1161 Telephone Number: 910-232-6962
Email: [e-mail] FaxNumber Email:[e-mail] FaxNumber:
Location of deed(s)or instrument(s): County: New Hanover Book: Page:
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: 11 • 3fl• 22 Name Chris Raughley Title VP of Land Development
Signature C.1..• Co,,,3/3,-
1, `-yy(-ono, ( - L-1(Le r a, c. ..- a Notary Public of the County of \tw a K e_ State of
North Carolina, hereby certify that CA, r, s e a.4... 1-.1.e. y 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 3b day of NO'/e-0-,b-e c ,20 0
Notary C. My commission expires -- t_f .
,:‘,,,SEAL
`�%``PNNO N'C F�/1/
Permission to Enter on Land - NO7-4L9 9C
I certify that I am authorized to grant and do in fact grant permission to the Erosion Control Insgecior ar1�his agents tgmter on
the land in question in connection related to this permit application. Sy .?l IG
CA,:-, It nn
�a.� 1 l • 3 22. '
CA,:-,. ''/I��U N i i ``.
Application Signature and" Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION