NCC241725_FRO Submitted_20240611

— v-4,0 APPLICATION FOR PERMIT FOR A File#
' �� LAND DISTURBING ACTIVITY
-, Under the conditions set forth by LD Fee Review Fee
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t, The New Hanover County
2 Ito w a Soil Erosion and Sedimentation Control Ordinance
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Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: Englebright & Long Holdings, LLC -
Mailing Address: 301 Harley Road Telephone Number: 919-633-4696 Fax Number:
Wilmington, NC 28405 Email Address: kirk a(�darkhorsestudios.com
Total Acres of Land Disturbance: 4.8 acres Purpose of Development: Proposed Studio
Description of Land Disturbance: Demo, grading, installation of underground utilities and storm drains
Address of Land Disturbance 215 N. Green Meadows Drive Latitude: 34° 15' 19" N Longitude: 77°51' 02" 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: Englebright & Long Holdings, LLC Name: Englebright & Long Holdings, LLC
Address: 301 Harley Road Address: 301 Harley Road
City/State: Wilmington, NC City/State: Wilmington, NC
Zip Code: 28405 Zip Code: 28405
Telephone Number: 910-633-4696 Telephone Number: 910-633-4696
Email: [e-mail] FaxNumber Email: [e-mail] FaxNumber:
Location of deed(s)or instrument(s): County: New Hanover Book: 6265 page: 2386
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: 3f r4c13 Name Kirk Englebright Title Manager
SignatureF.----. 't,-.'"'
I, i3Y%ezy 5 1d1• pt 1 S D Y a Notary Public of the County of N e W 14-aNDV 02, State of
North Carolina,hereby certify that lip YYA S t-i ii - Etilt1911lilt-appeared personally before me this day and
being duly sworn acknowledged that the aboveform was executed by him.
Witness my hand and notary seal,this 24 ,day of %..AAI'}2 ( r , 20 2-3, .
Notary\ ,��. My commission expires A14. � �P
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Permissi�rn�X�t► 4id,�►�`
I certify that 'att� r'zeJ gyant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the land i ues'tiofi�,',Y' A eetion related to this permit application.
App 'cation Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION