NCC240701_FRO Submitted_20240312

};� APPLICATION FOR PERMIT FOR A File l
0 "Iv I-, LAND DISTURBING ACTIVITY
z S.%--.7i, -� Under the eonditiotis set#orth by1 D Fee Review Foe_l- The Mew Hanover County3. Soilri- Erosion and Sedimentation Control Ordinance Date Pd Date Pd
Engineering Department. Clay Harvey G,L i4 & , la �''z C 0 41�-
Applicant or Applicant's Agent:
Mailing Address: 5605 Marsh Bay DR Telephone Number: 919-795-5481 i ax Number:
Email Address: [e-mail]
Total Acres of Land Disturbance: $1 Purpose of Development: Flex Warehouse Building
Description of Land Disturbance: Removing Of a couple trees and grading
Address of Land Disturbance 2019 Capital Drive, Wilmington Latitude:j‘31 l2... Longitude: O
STATEMENT OF FINANCIAL RESPONSIBILITY
Land owttsr(s)of record: Person or firm(s)financially responsible for the
land disturbing activity. If not a North Carolina
resident,you MUST have a INC. gen L ow)
Name:_ Clay Harvey Gz 14&iv �- Name: w. C.rye /,G t z ) LL
Address: 56_05 Marsh Bair Dr Address: 5 to 0 S- ivtof ' t- a i
ve.--
City/State: AA( ira tors- city/state: c; ‘W`,`yj
zip Code: 28409 Zip Code: C -9 CV, ) °-�
Telephone Number:919-795-5481 Telephone Number: (4 /1 " q C-"9(
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Emailclay@clhbuildinggroL Je Email:Gl ti P" ,'.11,9 , (c "paxNwnber:
Location of deed(s)or instrument(s):County: ^Book: Page:
The above information is tree 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.
Da : 1/24/2024 NameClay Harvey „ Owner/President
Signature -- —
I, a tary Public of the County of Xi al- State of
North Carolina,her ' y t appeared personally before me this day and
being duly sworn acknowledged that the form was ex4t , m•' ,..2
Notary (,�y �t��r4s U __..My co sion expires 2
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I certify t4j i ` to grant and do in fact grant permission to the Erosi Control Inspector and his agents to enter on
the land in riper noon ii ' lion relat it lication.
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Application Signature and Date
PLEASE COMPLE L PORTION OF APPLICATION