NCC224062_FRO Submitted_20221212

Engiineeriag Department
Applicant or Applicant's Agent:
APPLICATION FOR PERMIT FOR A
LAND DISTURBING ACTIVITY
Under the conditions set forth by
The New Hanover County
Soil Erosion and Sedimentation Control Ordinance
Joe Jacobus
Mailing Address: 2705 Castle Creek Lane
Wilmington, NC 28401
Telephone Number: 910-762-1986
LD Fee Review Fee
Date Pd Date Pd
Number: 910-762-1985
Email Address: [e-mail]
Total Acres of Land Disturbance: _ 2.3 ac purpose of Development: Sewer main installation
Description of Land Disturbance: Install sewer main to serve the property
Address of Land Disturbance 2705 Castle Creek Lane Latitude: 34 deg 17' 05" Longitude: -77 deg 55' 11 "
Land owner(s) of record:
Name: CHR Properties, LLC
Address: 622 Arjean Drive
City/State: Wilmington, NC
Zip Code: 28401
Telephone Number: 910-762-1986
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: CHR Properties, LLC
Address: 622 Arjean Drive
City/State: Wilmington, NC
Zip Code: 28409
Telephone Number:
910-762-1986
Email: [e-mail] FaxNnmber 910-762-1985 Email: [e-mail] Fax Number: 910-762-1985
Location of deed(s) or instrument(s). County:
New Hanover
Boole: 6181 page: 2114
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: —� S Q( Name., Joe Jacobus
Si
Title Manager
1, i , 4 n d a_ K Ckanr)bpj,5 a Notary Public of the County of /J1 J_AJ[+U_"'n 0 v_X41' State of
North Carolina, hereby certify that _ J 0 1a EJ a x appeared personally before me this day and
being duly sworn acknowledged that the above form was executed by him,
Witness my hand and notary seat, this Vh day of r , 20
Notary My commission expires . — 6r�2-g
SEAL
Permission to Enier on Land
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 in connection related to this permit application.
PLEASE COMPLETE ALL PORTIONS OF APPLICATION