NCC222230_FRO Submitted_20220620

Engineering Department
Applicant or Applicant's Agent:
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
Date Pd Date Pd
Rachels' Place, LLC
Mailing Address: 6622-A Gordon Road Telephone Number: 910-264-8518 Fax Number:
Wilmington, NC 28411 Email Address: brettbostic@ ahoo.com
Total Acres of Land Disturbance: 7.5 ac Purpose of Development: 50 Units Townhome Residential Development
Description of Land Disturbance:
Grade area for new townhome development
Address of Land Disturbance 3001 Blue Clay Road Latitude: 34 deg 17` 36" Longitude: -77 deg 54' 35"
Land owner(s) of record:
Name: Rachel's Place, LLC
Address: 6622-A Gordon Road
City/State
Wilmington, NC
Zip Code: 28411
Telephone Number: 910-264-8518
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: Rachel's Place, LLC
Address: 6622-A Gordon Road
City/State: Wilmington, NC
Zip Code: 28411
Telephone Number:
910-264-8518
Email: [e-mail] FaxNuntber Email: [e-mail] FaxNumber:
Location of deed(s) or instrument(s): County
2693-2695
The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath.
(This forth 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
Signai
New Hanover
Book. 6472 Page
Title Managing Member
I, Ax' s R !, a Notary Public of the County of , j' Q State of
North Carolina, hereby certify that e-c4 130W appeared personally before me this day and
being duly sword ac 1pq&e at the above form was executed by him.
Witness my h �4 f eak. this 144h day of 08�'' , 20 2-- l
Notary My commission expires _—V"Y Z0��
PermissAe '_En er n
I certify thaid:U �tfrti�to grant and do in fact grant permission to the Erosion Control Inspector and his agents to enter on
the land in question xn connection related to this ermit ap ication.
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION