NCC242554_FRO Submitted_20240912

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�o , `�.�, APPLICATION FOR PERMIT FOR A
�4 ��� LAND DISTURBING ACTIVITY File#
Under the conditions set forth
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-t The New Hanover County
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f Soil Erosion and Sedimentation Control Ordinance
F�Lus�up`�:' Date Pd Date Pd
N&T#23044
Engineering Department
Applicant or Applicant's Agent: Norris &Tunstall Consulting Engineers, P,C./T.Jason Clark, P.E.
Mailing Address: 2602 Iron Gate Drive, Suite 102 Telephone Number: 910-343-9653 Fax Number: 910-343-9604
Wilmington, NC 28412 Email Address: [e-mail] &[e-mail]
Total Acres of Land Disturbance:3.a(New) Purpose of Development: ( 1
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Description of Land Disturbance: i ,YLL 1�1�‘Q, t� f�6t1 % S � )kt {►(k, iL,
1308 Crooked-PPine Road °Address of Land Disturbance Latitude: 8' 15.74" N Longitude:77 49'41.03"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: TDR-HL, LLC Name: TDR-HL,LLC
Address: P.O. Box 381 Address: P.O. Box 381
City/State: Wrightsville Beach, NC City/State: Wrightsville Beach, NC
Zip Code: 28480 Zip Code: 28480
Telephone Number: 910-231-6099 Telephone Number: 910-231-6099
Email: [e-mail] FaxNumber N/A Email:[e-mail] FaxNumber: N/A
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: `a7
- / r2 Name William J. Bland Title Manager
Signature . _
I, ti a Notary Public of th County of � l ����� /Q _State of
North Caroli hereby certify that U..11 ri I appeared personally before me this day and
being duly sworn acknowledged that the ab�rve form was ex cured by him.
Witness my i nd and of y se. this 10 day of 1(� , 20
Notary ..
..''`: '��.� . MA/3 My commission expires LJ - 6 �, • i_ii •
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Perm?szio�to Enter o aTir
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I certify ;,t"l,dj '"utk Aril to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the land in dutlitni i`connection related to this permit application.
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Application Signature and Date '�Illam . Bland, Manager
PLEASE COMPLETE ALL PORTIONS OF APPLICATION