NCC215642_FRO Submitted_20211013

APPLICATION FOR PERMIT FOR A 4P; Z-�--Dopig File; y
CTIVITY
LAND DISTURBING A
Under the conditions set forth by
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Engineering Department
Applicant or Applicant's Agent. CSD Engineering
LD Fe4254R view Fee
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Date Pd�a ate Pd p h _
Mailing Address: PO BOX 4041 Telephone Number: - Fax Number: 910-791-1501
Wilmington NC 28406 Email Address: [e-mail]
Total Acres of Land Disturbance: 0.78 Purpose of Development: New Building and parking lot
Description of Land Disturbance: Land grading for new drive aisle, parking lot, building and pond
Address of Land Disturbance 3408 Enterprise Drive Latitude: 34D18' 0" Longitude:-77D52'38"
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: Pyramid Real Estate Holdings, LLC Name: Pyramid Real Estate Holdings, LLC
Address: 6266 Mallard Drive
Address: 6266 Mallard Drive
City/State: Wilmington, NC City/State: Wilmington NC
Zin Code: 28403 Zip Code: 28403
Telephone Number: 910-471-7091 Telephone Number: 910-471-7091
Email: Brian.dineen@ qua litychemlabs.coTaxNumber Email: [e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 5684 Page: 2508
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: 16 -- � - 2 d
Signature
Name Dr. Yousry Sayed
Title Manager
I, I .., ij h '. % I a Notary Public of the County of r State of
North Carolina, hereby certify that ctSr-CS 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, thi, �i 'y oftlfl , 20 a -
Notary _ k'Cr.� My commission expires
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SEAL = My = _.
COMMISSION EXPIRES = I
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Permission to Enter on Land
I certifythat I am authorized to granf' g�,V% ��t grant permission to the Erosion Control t a it's a ents to enter o
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the land in question in :onnection related to this permit application.
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Application Signa a and Date
LEASE COMPLETE ALL PORTIONS OF APPLICATION