NCC243162_FRO Submitted_20241016

�,00NT' .4, APPLICATION FOR PERMIT FOR A
LAND DISTURBING ACTIVITY File#
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"�: Under the conditions set forth by LD Fee Review Fee
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_ The New Hanover County
z li!oi .l t 1 s2 Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
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Engineering Department
Applicant or Applicant's Agent: GL&SM Limited Partnership (Greg Taylor)
Mailing Address: 5146 Masonboro Harbor Dr Telephone Number: 910-251-1181 Fax Number:
Wilmington, NC 28409 Email Address: [e-mail]
Total Acres of Land Disturbance: 1.4 Purpose of Development: Commercial
Description of Land Disturbance: Grading and construction of parking, drives, buildings, and utilities.
Address of Land Disturbance 701 Piner Rd Latitude:34DEG 8' 18.446" N Longitude:-77DEG ss'20.615'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: GL &SM Limited Partnership (Greg Taylor) Name: GL&SM Limited Partnership(Greg Taylor)
Address: 5146 Masonboro Harbor Dr Address: 5146 Masonboro Harbor Dr
City/State: Wilmington, NC City/State: Wilmington, NC
Zip Code: 28409 Zip Code: 28409
Telephone Number: 910-251-1181 Telephone Number: 910-251-1181
Email: [e-mail] FaxNumber Email:[e-mail] FaxNumber:
Location of deed(s)or instrument(s): County: New Hanover Book: 3430 page: 0030
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 i formation should there be any change in the information provided herein.
Date:04/01aq Name Greg Taylor Title Member/Manager
Signature
I, 1--le_(t r S. L,/h't 4-!e y a Notary Public of the County of Nem/ Nano v State of
North Carolina,hereby certify that G3Ye3 I a.y1or 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 /D i-h day of aJ_ r1L . 20 a 4 .
Notary ` .[f y ✓��N
y, L. ea . %Ntttttot►//ji (2 My commission expires ,3 wa
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Permission t Enter on Land yq'••,�3.pg.26 ..or, ....
I certify that am a thorized to grant andlicr fiR j�ermission to the Erosion Control Inspector and his agents to enter on
the land in scion i connection related to this p ���application.
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION