NCC233785_FRO Submitted_20231222

coo N Tr.4, APPLICATION FOR PERMIT FOR A
(1)
' LAND DISTURBING ACTIVITY File#
4 Under the conditions set forth by
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, _o I D Fee Review Fee
-t : The New Hanover County
I_ � Soil Erosion and Sedimentation Control Ordinance
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Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: ER of Wilmington, LLC
Mailing Address: 2029 Eastwood Road, Unit 143 Telephone Number: 910-352-6110 Fax Number:
Wilmington, NC 28411 Email Address: [e-mail]
Total Acres of Land Disturbance: 1.14 ac Purpose of Development: 2 -quadplex residential buildings
Description of Land Disturbance: Grade area for new townhome development
Address of Land Disturbance 109 & 111 Giles Avenue Latitude: 34 deg 12'38" Longitude: -77 deg 50'25"
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
Name: ER of Wilmington, NC resident,you MUST have a N.C.agent.(List Below)
Name: ER of Wilmington. NC
Address: 2029 Eastwood Road, Unit 143 Address: 2029 Eastwood Road, Unit 143
City/State: Wilmington, NC City/State: Wilmington, NC
Zip Code: 28411
Zip Code: 28411
Telephone Number: 910-352-6110 Telephone Number: 910-352-6110
Email: [e-mail] FaxNumber Email: [e-mail] FaxNumber:
Location of deed(s)or instrument(s): County: New Hanover Book: 6589 Page: 1539-1541
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 correc i ormation should there be any change in the information provided herein.
Date: / 3 Name Mark Resier
Title Member
Signature
I, / G7?ti C c c/C a NotaryPublic of the County of Net-, al,e/ State of
North Carolina,hereby certify that (1/1 ,K Tase,/ appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my hand,_andnotary spal,this 19'i`` day of /174'(9 ,20 2-3
Notary /
My commission expires (I/0 3 1 a-e 2 LI
SEAL Tanya Mack
NOTARY PUBLIC
New Hanover County,NC
My Commission Expires November 3,2024
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant perm-melon to tho Erosion Control inspector and.Ins agents to enter on
the land in question ' connecti related to this permit applicatio .
i//72.3
Application ignature and Date
s
PLEASE COMPLETE ALL PORTIONS OF APPLICATION