NCC223551_FRO Submitted_20221021

APPLICATION FOR PERMIT FOR A Fileil
LAND DISTURBING ACTIVITY LD Fee Review Fee_
Under the conditions set forth by Date Pd _ Date I'd
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Engineering Department
Applicant or Applicant's Agent: _ AJ McGirt Land Management, LLC
Mailing Address: _PO Box 15148 Telephone Number: 9I0-612-6762 Fax Number: 910-796-0286
_ Wilmington, NC 2-9409 Email Address: tre c q-)bellsouth.net
Total Acres of Land Disturbance: 4.1 acres Purpose of Development: _Self Storage & & Boat & Trailer Storage
Description of Land Disturbance:_ Clear and grade area for store & storage site
Address Description of Land Disturbance: 3829 Carolina Beach Road Latitude: 34' 10' 28" Longitude: 77' 55' 27"
Land owner(s) of record:
Name: AJ McGirt Land Manaeement, LLC
Address: PO Box 15148
CitylState: Wilmin on NC
Zipcode: 28408
Telephone Number; 910-612-6762
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: AJ McGirt Land Management. LLC
Address:
PO Box 15148
City/State:_
Wilmington, NC
Zipcode:
28408
Telephone ##
910-612-6762
Email: treymcgObellsouth.net _ FaxNumber._910-799-3006— Email [e-mail] FaxNumber: 910-796-0286
Location of deed(s) or instrument(s): County: New Hanover County Book: BK 6083 Page: PG 2565-2579
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: ! Name Archie J. McGirt 111 Title Manager —AJ McGirt Land Management, LLC_
Signature
—a Notary Public of the County of I4�w ffAM [< State of North C
appeared personally before me this day and being duly sworn acknowledged
executed by him. E f 7
Witness my nd and notaria sea , his I L day of 20� = NOTA�%� fi
Notar l/t My commission expires o�ps� x� A143!G
SEAL %1:VA1 _IXAI AI
Permission to Enter on Land "'ryN1tHtµ`"
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 question
�a eonnnee:oy'.�Y'rcd ro sh:s po.m=t app��=eta on.
Signature and Date