NCC232545_FRO Submitted_20230823

c.��NTY.,t, APPLICATION FOR PERMIT FOR A File#
' , LAND DISTURBING ACTIVITY
z Wit.
Under the conditions set forth by LD Fee Review Fee
<( 04114`. _o
�. Till'
�2 The New Hanover County
Soil Erosion and Sedimentation Control Ordinance Date Pd Date Pd
Engineering Department Andy Mueller
Applicant or Applicant's Agent:
Mailing Address: 3240 Torringdon Way, Suite 210 Telephone Number: 301-922-3962 Fax Number:
Charlotte, NC 28277 Email Address: [e-mail]
Total Acres of Land Disturbance: 46.07 ac Purpose of Development: Industrial Park
Description of Land Disturbance: 4 Proposed warehouse buildings with associated parking/utilities/infrastructure.
Address of Land Disturbance 2830 US Highway 421 Latitude:34.277 Longitude: -77.958
Wilmington, NC
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,von MUST have a N.C.agent.(List Below)
Name: 2830 Highway 421 Owner, LLC Name: Corporation Service Company
Address: 200 Garden City Plaza, Suite 325 Address: 2626 Glenwood Ave Suite 550
City/State: Garden City, NY city/state: Raleigh, NC
3 Zip Code: 11530 Zip Code: 27608
Telephone Number: 516-837-8000 Telephone Number: 516-837-8000
Email daniel.schor@treelineFaxNumber Email: daniel.schor@treeline FaxNumber:
comLocation pdeed(s)or instrument(s): County: New Hanover County ofrn
book: 6954 Page: 2359
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: l 1-1-2 ,- Name 1JUI(J �✓ TitleA M j gtke
dvai
Signat e
I1,0
, �/a rp/ an a Notary Public of the County of f State of
t•'lit t.}'"` hereby certify that (.. 'J'�o r- appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my hand and t seal,al' .1_L___day of 1-W- ,20�3 .
, � �4 commission expires g'3/Zk, .
Notary y p
CAROL KANTOR
SEAL Notary Public,State of New York
No.01 KA4732765
Qualified in Nassau County _
Commission Expires August 31,20
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the 1 in quesionati connection related to this permit application.
fs11,3
A lication SignAtur and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION

„n,t APPLICATION FOR PERMIT FOR A File#
•` LAND DISTURBING ACTIVITY
z ..,' Under the conditions set forth by LD Fee Review Fcc
OAs The New Hanover County
��' r la am/ Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
Engineering Department Andy Mueller
Applicant or Applicant's Agent:
Mailing Address:
3420 ToringdonTelephone Way,Suite 210 Tele hone Number: 301-922-3962 Fax Number:
Charlotte,NC 28277 Email Address: [e-mail]
Total Acres of Land Disturbance:
7.61 ac Purpose of Development: Industrial Park
1 proposed warehouse building with associated parking/utilities/infrastructure
Description of Land Disturbance:
Address of Land Disturbance
2830 US Highway 421,Wilmington,NC 28401 Latitude:34.277 Longitude:-77.958
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.von MUST have a N.C.agent.(List Below)
Name:
NN Bleeker NC LLC Name: Corporation Service Company
Address: 111 Great Neck Road,Suite 301 Address: 2626 Glenwood Ave, Suite 550
City/State: Great Neck,NY City/State: Raleigh, NC
Zip Code: 11021 Zip Code: 27608
Telephone Number: [phone] Telephone Number: 704-994.5400
Email:
[e-mail] Email:danlel.schorMeelinemmpanies,00m 1~a\Number:
Location of deed(s)or instrument(s):County:
New Hanover County Book: 6613 page: 1790-1794
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. c
Date: 2r��Z Name �lil!l 'sj✓ Title m �°��° `,
Signatu
I, (�} / 4,..rhy
a Notary Public of the County of tig=�- -t State of
�''p tltl arr hereby certify that nth_ 0 ( appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.Witness my hand an ota seal. is day of A t 20 23 3 l-2,
Notary r My commission expires
SEAL CAROL KANTOR
Notary Public,State of N3WYork
No.01KA4732765
Qualified in Nassau County
Commission Explres August 3l,202P
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the t uestio • ngection relate to this permit application.
g zl 113
Applation Signa re d Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION

,,,T,. APPLICATION FOR PERMIT FOR A File#
LAND DISTURBING ACTIVITY
z 3• ;_ Under the conditions set forth by LD Fee Review Fee
`, - The New Hanover County
H. ,g 41 .
Soil Erosion and Sedimentation Control Ordinance Date Pd Date Pd
Engineering Department Andy Mueller
Applicant or Applicant's Agent:
Mailing Address: 3420 Toringdon Way,Suite 210 Telephone Number: 301-922-3962 Fax Number:
Charlotte,NC 28277 Email Address: [e-mail]
24.21 ac Industrial Park
Total Acres of Land Disturbance: Purpose of Development:
2 proposed warehouse buildings with associated parkinglutilitieslinfrastructure,water main extension
Description of Land Disturbance:
Address of Land Disturbance
2830 US Highway 421,Wilmington,NC 28401 Latitude:34.277 Longitude:-77.958
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: Piedmont Developers LLC Name: Corporation Service Company
Address: 200 Garden City Plaza,Suite 325 Address: 2626 Glenwood Ave, Suite 550
City/State: Garden City,NY City/State: Raleigh, NC
Zip Code: 11530 zip Code: 27608
Telephone Number:
[phone] Telephone Number: 704.994-5400
Email:
daniel.sct orItreelinecompanies.com FaxNumber Email:daniel.arhorareellnecompanles.com FaxNumber:
New Hanover County6610 1720-1723
Location of deed(s)or instrument(s):County: 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: 6q-441--;"
1
Name ti CI i� Title AvArt.;krA CIS114761
Signre
t } rt.)/ 1 rrft-7 a Notary Public of the County of )Zct u- State of
Nert
�` P� ma,hereby certify that_ 2 n►0 __... v)( appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
1 n 2pvsf 2023
Witness my hand an. •tary seal, is . day of J
Notary ,t /ice My commission expires 9-31-2‘ •
,-
CAROL KANTOR
SEAL Notary Public,State of New York
No.01KA4732765
Qualified in Nassau County
Commission Expires August 31,20? '
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the d in que .on Jn connection related to this permit application.
gi7, II;
A plication gnat e and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION