NCC233293_FRO Submitted_20231109

Orange County Planning & Inspections Department
ORANGE 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
INA 919-245-2575 or planningapps(a orangecountvnc.gov
NORTH CAROL
Land Disturbance Permit (LDP) Application e-v19
0
Please refer to instructions and checklist in completing the following application. / /
If completing by hand, please use black or blue ink.
Date: 6'S'Z3 Case Number: LOP 23 " 009
Check all that apply: n Erosion Control Plan
Stormwater Permit
n Stormwater Management Plan .()%2.3-00H 0
General Submittal Information
Name of Project: Homestead Road Townhomes 5ovc.c„'.
Parcel ID Number (PIN): 9870907642 Planning Jurisdiction: Chapel Hill
Size of Tract: 15.65 acres Area Disturbed 14.12 acres 615 0 ?. 2,®.5F
Fees-Section Completed by Staff
4118
ountErosion Control Plan Review
lit" Land Disturbing Permit [[/� t °
A �on Optional with Initial Application $0,472 c � �v�. O Q�7 2
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $
Total $ 1940' .0118
Approximate date land disturbance will begin: °/ ( i 9093
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: GS Homestead, LLC Name:
Street Address: 121 S. Estes Dr. Suite 100 Street Address:
Chapel Hill, NC 27514
Current Mailing Address: Same Current Mailing Address:
City: City:
State: Zip: State: Zip:
Phone: [phone] Phone: r
Email: [e-mail] Email:
RCc_ 4, -C-2-) Page 1 of 4
ro S)(z/ -

Contract Purchaser (if applicable) (Use additional pages,if necessary and attach to application):
Company/Organization: Company/Organization:
Contact Person: Contact Person:
Street Address: Street Address:
Current Mailing Address: Current Mailing Address:
City: City:
State: Zip: State: Zip:
Phone: Phone:
Email: Email:
Person(s) or Firm(s) Financially Responsible for this Land Disturbing Activity:
Company/Organization: GS Homestead, LLC Company/Organization:
Contact Person: Richard Gurlitz Contact Person:
Street Address: 121 S. Estes Dr. Suite 100 Street Address:
Chapel Hill, NC 27514
Current Mailing Address: Same Current Mailing Address:
City: City:
State: Zip: State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
Registered Agent(if any) for the Person(s),or Financially Responsible Party:
(NOTE: a North Carolina agent is required if the applicant is not a resident of North Carolina)
Name: Name:
Street Address: Street Address:
Current Mailing Address: Current Mailing Address:
City: City:
State: Zip: State: Zip:
Phone: Phone:
Email: Email:
Page 2 of 4

Additional Project Information
Project Description (detail the scope of the project and nature of land disturbance):
Site clearing and grading for construction of roads, utilities and building pads for new residential
subdivision.
Plans Prepared.by:
Name of Person/Firm: Stewart
Contact Person: Tim Summerville
License Number: 036418
Mailing Address: 101 West Main Street
City: Durham State: NC Zip: 27701
Phone: [phone] Email: [e-mail]
Page 3 of 4

Certification and Signatures
' nature and Witness: The above information is true and correct to the best of my knowledge and
el f and w s ovid b me while under oath.
` e-6.-tt�c P6-Wiz-LAi 7 Z
ignature o financially Responsible Party Type or Print Name Legibly
fi - 45 140M%1Ao U.c- Hilti 51f Z-3
Tit - or Authority, Date
I, iii, ' '. -ri L.• i me , N ,t , , a Notary Public of the County of
hereby certify that % ` t - personally before me this day and
under oath acknowledged that,thispplication 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 f Day of IVIeel , 49i6A5
__
Signature of Nota Tbawn L. Micena My Commission Expires
Notary Public
Wake County
North Carolina
SEAL
Property Owner Acknowledgement
I hereby acknowledge the above information and parties referenced herein have been granted
ission to con uct dev opment activity on referenced property of which I own.
u4 o 6--vv...v
ignature of Pr perty Owners Type or Print Name Legibly
NMI 5 I z
Date
I a Notary Public of the County of 1,14L,
hereby certify that `SIC r ,i personally before me this day and
under oath acknowledged that th' 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, this51 Day of lk, ,
Signature of Notary My Commission Expires
SEAL s Dawn L. Micena s
5 Wake County S
ti .__North Carolina s
Page 4 of 4