NCC215576_FRO Submitted_20220125

APPLICATION FOR PERMIT FOR A
LAND DISTURBING ACTIVITY
4 s Under the conditions set forth by
lThe New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Engineering Department
Applicant or Applicant's Agent: Bauen Group, Inc.
Mailing Address: 244 Princess Street, Suite 206
Wilmington, NC 28401
File #
LD Fee Review Fee
Date Pd Date Pd
Telephone Number: 910-300-9314 Fax Number:
Email Address: [e-mail]
Total Acres of Land Disturbance: -268 acres purpose of Development: To build a single family home.
Description of Land Disturbance: To build a single family home.
Address of Land Disturbance 1636 Osprey Cove Court Latitude: Longitude:
Land owner(s) of record:
Name: Eric Davis
Address: 1024 N. 3rd St.
City/State: Wilmington, NC
Zip Code: 28401
Telephone Number: 917-846-0101
STATEMENT OF FINANCIAL RESPONSIBILITY
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: Bauen Group, Inc.
Address: 244 Princess Street, Suite 206
City/State: Wilmington, NC
Code: 28401
Telephone Number: 910-300-9314
Email: [e-mail] FaxNumber Email: [e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 6408 Page: 701
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: 8-18-21
Signature
Name Eric Davis
Title President
I, IF _FEaC.(,A -Ma,. I n-±± a Notary Public of the County of u re HAS State of
North Carolina, hereby certify that L 1)A- yk appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness in hand and notary seal, this day of An AZ,�( It5+ , 20
Notary L�1P 'i7� `'�� - My commission expires � `� Z
SEAL REBECCA MALOTT
Notary Public
North Carolina
Permission to Enter on Land C o l u m b u s C o u n t y
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
related to this permit application.
Application Signat* and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION