NCC242476_FRO Submitted_20240815

Revised 5/14/2024
Orange County Planning & Inspections
Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or planningapps(a orangecountync.gov
Land Disturbance Permit (LDP) Application
Please refer to instructions and checklist in completing the following application.
If completing by hand, please use black or blue ink.
Date: Case Number:
Check all that apply: CJ Erosion Control Plan
❑ Stormwater Permit
❑ Stormwater Management Plan
General Submittal Information
Name of Project: Buckhorn Business Centre, Phase 3
Parcel ID Number (PIN):
9834071008, 9824961908 Planning Jurisdiction: Mebane
Size of Tract: 25.61 acres Area Disturbed 17.57 acres
Fees — Section Completed by Staff
Fee Amount
Erosion Control Plan Review 1 295
Required with Application $
Land Disturbing Permit
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $
Total $
Approximate date land disturbance will begin: August 15, 2024
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Buckhorn Centre, LLC Name:
Street Address: 7201 Creedmoor Road, Suite 140 Street Address:
Current Mailing Address: Same Current Mailing Address:
City: Raleigh City:
State: NC Zip: 27603 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
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Revised 5/14/2024
Contract Purchaser (if applicable) (Use additional pages if necessary and attach to application):
Buckhorn Industrial III
Company/Organization: Property,LLC Company/Organization:
Contact Person: Travis Covington Contact Person:
Street Address: 675 Bering Drive, Suite 825 Street Address:
Current Mailing Address: Current Mailing Address:
City: Houston City:
State: TX Zip: 77057 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
Person(s) or Firm(s) Financially Responsible for this Land Disturbing Activity:
Buckhorn Industrial III
Company/Organization: Property,LLC Company/Organization:
Contact Person: Travis Covington Contact Person:
Street Address: 675 Bering Drive, Suite 825 Street Address:
Current Mailing Address: Same Current Mailing Address:
City: Houston City:
State: TX Zip: 77057 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
As the Financially Responsible Party, I consent to receiving
notifications regarding this project through electronic
communication. [e-mail]
(Email) (Initials)
I agree to provide any updated email addresses as necessary The Financial Responsible Party is responsible for the
to ensure consistent communication is maintained between distribution of correspondence from Orange County to other
myself and Orange County Sedimentation and Erosion pertinent parties.
Control. Electronic notifications may include Plans Review
Comments, Approvals, Disapprovals Notices of Violation,
Stop-Work Orders, and/or Civil Penalties.
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Revised 5/14/2024
Registered Agent (if any) for the Person(s) or Financially Responsible Party:
(NOTE: a North Carolina agent is required if the applicant is a company or is not a resident of North Carolina)
Name: CT Corporation System Name:
Street Address: 160 Mine Lake Ct, Suite 200 Street Address:
Current Mailing Address: Same Current Mailing Address:
City: Raleigh City:
State: NC Zip: 27615 State: Zip:
Phone: Phone:
Email: Email:
Additional Project Information
Project Description (detail the scope of the project and nature of land disturbance):
Site clearing and grading for construction of 2 warehouse buildings with associated roadways
and parking.
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Revised 5/14/2024
Plans Prepared by:
Name of Person/Firm: Stewart Inc
Contact Person: Pamela Kisner
License Number: 023121
Mailing Address: 223 S. West Street, Suite 1100
City: Raleigh State: NC Zip: 27603
Phone: [phone] Email: pkistner©stewartinc.com
Certification and Signatures
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.
Travis Covington
Signature of Financially Responsible Party Type or Print Name Legibly
?aes i .►r -- vEi. f 7— '1-.11. 2q
Title or Authority Date
1, by%l l 'ftak i-h a Notary Public of the County of
hereby certify that CamJ i r\I C-C71)N 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 I Statement of Ownership and Financial
Responsibility was executed by him or her.
Witness my hand and notarial seal, this 11 Day of 30.1/4.1 , 20 2-4
�-c O G/i / 20 Z-/
Signature f Notary My Commission Expires
SEAL <<,•.•"\ �•9"v
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Revised 5/14/2024
Property Owner Acknowledgement
I hereby a •wledge the above information and parties referenced herein have been granted
permis:'on 4 c ndu development activity on referenced property of which I own.
�/ G `T7 t LE)zzb
Signature of ro rty Owners Type or print N me Legibly
-)// 4-4
Date
I, CWckC,6 Wo\) xv\-S a Notary Public of the County of Wotiede
hereby certify that ( \(ir, ( .(t7_7 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 t6+4bay of Tull , 2J324
Signature off/P6Cy My CornmAsion Expires
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Page 5 of 5