NCC231219_FRO Submitted_20230510

A �'¢��. APPLICATION FOR PERMIT FOR A �.File o 0 LAND DISTURBING ACTIVITY _._A-...__._
< , Under the conditions set forth
x 0 by I.D Fee_ -_—Review Fee_
The New Hanover County
,1 Soil Erosion and Sedimentation Control Ordinance
Date KI Date Pd
.........)
Engineering Department
Applicant or Applicant's Agent: . VRL Builders Group, LLC dba Vince Lutheran Homes
Mailing Address: 403 Peninsula Drive.Carolina Beach.NC 28428 Telephone Number: 910-279-0145 Fax Number:
_Email Address: vinson.lutheran@gmail corn
Total Acres of Land Disturbance: 32 AC A?"'rpose of Development:ent: New Single Family Constructon
Description of Land Disturbance: Light Grading -
Address of Land Disturbance 5913 Nautical Isle Court Latitude: 34.138279 Longitude: -77.866859
STATEMENT OF FINANCIAL RESPONSIBILITY
Land owner(s)of record: Person or Brm(s)financially responsible for the
land disturbing activity. If not a North Carolina
resident,you MUST have a N.C.agent.(List Below)
Name:- Bagshaw.Jeff&Melinda Name: VRL Builders Group.LLC dba Vince Lutheran Homes
Address: 4104 Rounding Bend Lane Address: 403 peninsula Drive f
City/State: _ Wilmington,NC , .City/Staff: Carolina Beach,NC
Zip Code:—28412 Zip Code: 28428 _
Telephone Number: 910-200-9912 Telephone Number: 910-279-0145
Email: bagshawjefflgmail.corn FaxNumber _ Email:[e-mail] ''axNuniber:
Location of deed(s)or instruinent(s): County: NHc Book: 6364 Page: 1627
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.
: _ v _ , a ►e__V/.E..,S.`S(?1 -.. i—A ' / ``ik-A) Title_ v'L---~`1 C5v2 -41,' .G jL
Sgriattire
I, t,.,i 3 .4.__"\ a Notary Public of the County of )'-") "-) `).-t, State of
North Carolina,hereby certify'D at \I t.r5o,." L ,`' C. /"\ 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 1 Yrday of_ t`Y\-0--/- _ ,20 D- .-
Notary ,~,..__ ...._ _. My comnssion expires ' 1 - -D - L
SEAR' 7" ..* ShflL.l�I? AU7RY
,,, Notary Public, North Carolina
7' New Hanover County
'' My C mis�n = Tres
Permission to.Enter on i..and `I 1. _ -''
xTEN'�t%g2ldYub���
I certify that I am authorized to grant and do in fact grant permission td"t€Erosion Control Inspector and his agents to enter on
the land nnection related to this permit application.
Co ) 1 .Zo.Z _ _
Application Signature and Date
PLEASE COMPLETE ALL PORTIONS OF APPLICATION