NCC221345_FRO Submitted_20220406

0RANGE COUNTY
NOWI'H CAROLINA
ORANGE COUNTY PLANNING AND INSPECTIONS
EROSION CONTROL AND STORMWATER DIVISION
APPLICATION
EROSION CONTROL PLAN
LAND DISTRUBING PERMIT (LDP)
STORMWATER MANAGEMENT PLAN (SMP)
131 W. Margaret Lane - Post Office Box 8181
Hillsborough, NC 27278
[phone]
https:/hvww.orangecountvnc.gov/ 1302/Erosion-Control-Stormwater
1. Name of Project: Hillsborough Family Fare
2. Parcel Identification Number (PIN): 9863897274 Planning Jurisdiction: Hillsborough
3. Size of Tract: 1.645 acres; Area Disturbed. 1.28 acres
4. Fees:
Erosion Control Plan Review 649
Required with Application $
Land Disturbing Permit 1 589
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only n/a
Required with Application $
Total $ 2,238
FOR OFFICE USE ONLY
Date Paid Receipt #
Date Paid Receipt #
Date Paid Receipt #
5. Approximate Date Land Disturbance Will Begin: Upon Permitting
6. Landowner(s) of Record: (Use additional pages if necessary and attach to application)
Joseph Earl Crews & Leslie L Crews
Name Name
5717 Country Ln Dr
Street Address
5717 Country Ln Dr
Current Mailing Address
Durham NC
City
State
Telephone Fax
Email Address
27705
Zip
Street Address
Current Mailing Address
City
Telephone
Email Address
State Zip
Fax
Page 1

Future Landowners (if applicable): (Use additional pages if necessary and attach to application)
Company / Organization Company / Organization
M.M. Fowler, Inc.
Contact Contact
Lee Barnes
Street Address Street Address
4220 Neal Road, Durham, NC 27705
Current Mailing Address
Current Mailing Address
4220 Neal Road NC 27705
City State Zip
City State Zip
Durham
Telephone
Telephone
919-309-2925
e-mail
e-mail
[e-mail]
7. Person(s) or Firm(s) Financially Responsible for this
Land Disturbing Activity:
Company / Organization:
Company / Organization:
M.M. Fowler, Inc.
Contact
Contact
Lee Barnes
Street Address
Street Address
4220 Neal Road, Durham, NC 27705
Current Mailing Address
Current Mailing Address
4220 Neal Road NC 27705
City State Zip
City State Zip
Durham
Telephone
Telephone
919-309-2925
e-mail
e-mail
[e-mail]
S. Registered Agent (if any) for the Person(s) or Firm(s) Financially Responsible:
(NOTE: a North Carolina agent is required if the applicant is not a resident of North Carolina)
n/a
Name City
Street Address Telephone
Current Mailing Address Email
State Zip
Page 2

9. Project Description:
This project proposes construction of a new convenience store building, canopy with fuel sates, and associated parking and support areas as shown on the site plan.
Page 3

10. Plaits Prepared By:
The L.E.A.D.S. Group, PA
Name of Person or Firm
505 Easi Davis Street
'`Mailing .Address
Burlington NC 27215
Gn State Zip
Chad Huffine
ontact rerson
[e-mail]
Email
336-227-8724
Telephone
Signature and Witness: the above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath.
Signature of Fin ncialh• Res nsi le
�t l Type or Prin Name Legible
Title or Authority i 17 J "
Date
a Notary Public of the County of
hereby certify that ,. � personally before me this day and under oath
acknowledged that this Application for Erosion Control Plan Approval, Stormwater Management Plan
Approval and Land Disturbing Permit / Statement of Ownership and Financial Responsibility
was executed by him or her.
Witness my hand and notarial seal. this _ Day of
SignatuAofNo!Ltary
MO
,t�61111/1//
SEAL
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—I.Y Com t ion Expires
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