NCC220964_FRO Submitted_20220309

APPLICATION FOR PERMIT FOR A
'\ LAND DISTURBING ACTIVITY
Under the conditions set forth by
The New Hanover County
\ - Soil Erosion and Sedimentation Control Ordinance
Engineering Department
Applicant or Applicant's Agent: Centre Pointe, LLC
Mailing Address: 1131-B Military Cutoff Road
Wilmington, NC 28405
Telephone Number: [phone]
File #
LD Fee Review Fee
Date Pd Date Pd
Number:
Email Address: [e-mail]
Total Acres of Land Disturbance: 20.33 AC Purpose of Development: Commercial Development
Description of Land Disturbance: Road Improvements, Utility Installation, and Grading for Commercial Development
Address of Land Disturbance 1521 Eastwood Road Wilmington, NC 28405 Latitude: 34.2301 Longitude: -77.8329
Land owner(s) of record:
Name: Centre Point, LLC
Address: 1131-B Military Cutoff Road
City/State: Wilmington, NC
Zip Code: 28405
Telephone Number: [phone]
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: Centre Point, LLC
Address: 1131-B Military Cutoff Road
City/State: Wilmington, NC
Code: 28405
Telephone Number: [phone]
Email: [e-mail] FaxNumber Email: [e-mail] FaxNumber:
Location of deed(s) or instrurnent(s): County: New Hanover Book: 6414 page: 2151-2152
The above information is true and correct to the best of my knowledge and belief and was provided by the 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: f
Signature _
Name i-na'! Title
I, V..0. k "ttu/ a Notary Public of the County of NLW Vku-vQV -ey" State of
North Carolina, hereby certify that -5-Q.SOr. 17 SW cc. '-_ appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notary sea], this 2 -0 day of 20 Z
Notary My commission expires / 30 • jl)4Q
0
„�,111frr1T1111
SEAL
Permission to Enter on Land
I certify that I am authorize"rant d 'Lfiyrct gr�t�t ermission to the Erosion Control Inspector and his agents to enter on
the land in question in-_ooifin*tion re
Application Signature
S
PLEASE COMPLETE ALL PORTIONS OF APPLICATION