NCC243600_FRO Submitted_20241120

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< y > Under the conditions set forth by LD Fee Review Fee
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The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Date Pd Date Pd
Engineering Department
Applicant or Applicant's Agent: Norris& Bland Consulting Engineers, P.C. /J. Phillip Norris, P.E.
Mailing Address: 1429 Ash-Little River Rd. Telephone Number: 910-287-5900 Fax Number:
Ash, NC 28420 Email Address: [e-mail] & twatson@ nbengr.com
Total Acres of Land Disturbance: 3• te a Purpose of Development: Oe,mp`l 44 or t9c e.`t\S'11 h r, -Iret,ok
eo u..cNA tOr\ 0-.`A, ‘4)U,A t A..Z CA S
Description of Land Disturbance: -Jame 0.S cu re oSe
Address of Land Disturbance oZOOS N t6 ' 51r.
1 . \ ►'n.tr atitude: 39.t. as-9- Longitude:— 77.9%
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: Isambard 53 LLC Name: Isambard 53 LLC
Address: 332 Military Cutoff Rd. Address: 332 Military Cutoff Rd.
City/State: Wilmington, NC City/State: Wilmington, NC
Zip Code: 28405 Zip Code: 28405
Telephone Number: 910-338-3585 Telephone Number: 910-338-3585
Email: [e-mail] FaxNumber Email:[e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 6646 Page: 272
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:'`o\'D Name Robert J. Hollis Title Manager
Signature 4 -
I, ---� t`k'\9.,A C- .(,2 , a Notary Public of the County of 5 J .\ Gs\C-1,R)'— State of
North Carolina,hereby certify that Q ,a:--- J . \\c \. appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness y hand and notary set,this. day of v.L1. L�` ,20 c1-y .
Notar -' • 4_1 t My mmission expires ----\ -
Kiehli Gore
SEA ,IOTARV PUBLIC
New Hanover County
North Carolina
My Commission Expires 08/25/26
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 land in ues ' • ection related to this permit application.
_______) .-c,\,,,_ 00\
Application Signature and Date '
PLEASE COMPLETE ALL PORTIONS OF APPLICATION