NCC221036_FRO Submitted_20220324

APPLICATION FOR PERMIT FOR A File #
LAND DISTURBING ACTIVITY
Under the conditions set forth by LD Fee Review Fee —
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance pate Pd Date Pd
Engineering Department
Appiicant ox Applicant's Agent: Todd Best - Manager of Facilities and Maintenance - GE Hitachi Nuclear
Mailing Address: 3901 Castle Hayne Road
Wilmington, NC 28401
Total Acres of Land Disturbance: 0.12
Telephone Number: 910 547-1033 Fax Number: 910-392-6810
Email Address:
Purpose of Development:
[e-mail]
pave two areas at WFSC with a disturbed area of 0.12 ac
Description of Land Disturbance: grading areas to pave two small areas
Address of Land Disturbance 3901 Castle Hayne Road Latitude. 34' 19 28 Longitude: 77' 5s' 35^
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: General Electric Company Name: General Electric Company
ea.1,P��• 3901 Castle Hayne Road Address: 3901 Castle Hayne Road
City/State.
Wilmington, NC
Zip Code: 28401
City/State: Wilmington, NC
Zin Code: 28401
Telephone Number: 910-547-1033 Telephone Number: 910-547-1033
Email: [e-mail] F•axNumber 910-392-6810 Email: [e-mail] FaxNumber:
910-392-6810
Location of deed(s) or instrument(s): County: New Hanover Book: 8Q6 Page: 458462
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: L I / Z ° .Z z Name Todd Best
Signature .2`i
Title Facilities Manager
I, f = . j j 7/, /,,o d_��I P _ � a Notary Public of the County of I1�Pa � J O�in1� _ State of
North Carolina, hereby certify that DOW S T 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 day of F hko'd4lZ1K , 20 2 2
Notary " w My commission expires D'l -dOd 3
SEAL��.•�pYARF�'
_C:)
Permission to Enter on Land
I certify that I am authorizedA,.ct grant permission to the Erosion Control Inspector and his agents to enter on
ER
the land in question in connection ri s permit application.
2 i Z a 'L Z.
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION