NCC222651_FRO Submitted_20220725

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: Evans General Contractors- LLC
File #
LD Fee Review Fee
Date Pd Date Pd
Mailing Address: 4509 Creedmoor Road, Suite 401 _ Telephone Number: [phone] Fax Number:
Raleigh_ NO 27612 Email Address: sholfook(Wevans-gc-com
Total Acres of Land Disturbance: 36.49 Purpose of Development: Cold Storage aellity
Description of Land Disturbance: Clearing and grading, for future improvements.
Address of Land Disturbance 2404 Blue Clay Road Latitude:_34° 16- 52.83"N Longitude: 77° 54- 46.10"W
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: New Hanover C.QWnty Airport Authority Name: Evans General Contractors, LLC (Sam Holbrook -Vice President]
Address: 1740 Airpprt Boulevard, Suite 12 Address: 4509 Creedmoor Road. Suite 401
City/State: Wilmington. NC City/State: Raleigh, NC
Zip Code: 28405 _Zip Code: 27612
Telephone Number: [phone] Telephone Number: [phone]
Email: [e-mail] FaxNumber(910) 341-4365 Email: [e-mail] FaxNumber:
Location of deed(s) or instrument(s): County: New Hanover Book: 36ol Page: oo34
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 tc
provide corrected information should there be any change in the information provided herein.
Date: Name S AM %'O Lam, QRXY.
Signature —-�_
Title VP
I, U f t I h a Notary Public of the County of vg1a lu State of
North Caro ina, hereby certify that nL 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 dr" day of A-L 20
Notary
My commission expires ()� -
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Permission to a G � 025503
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I certify that I am ala lit and do in fact grant permission to the Erosion Control In"stIn enter on
the land in question in connection related to this permit application. �'11",�gR p eOA
4tL (W G I � 4 -
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION