NCC243497_FRO Submitted_20241115

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or planningapps(a�orangecountVnc.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.
* Please fill out all required fields
Date: 04 November 2024 Case Number:
Check all that apply: ,/ Erosion Control Plan
Stormwater Permit
Stormwater Management Plan
General Submittal Information*
Name of Project: South Green Flats - Lot 2
Parcel ID Number (PIN): 9778-93-1738 Planning Jurisdiction: Carrboro
Size of Tract: 2.99 acres Area Disturbed 2.36 acres
Fees —Section Completed by Staff
Fee Amount
Erosion Control Plan Review $ ,
1008
Required with Application
Land Disturbing Permit 2 016
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only N/A
Required with Application $
Total $3,024
Approximate date land disturbance will begin: Autumn 2024
Contact Information*
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: South Green Bluff, LLC Name:
Street Address: 100 Timberhill Place Street Address:
Suite 129
Current Mailing Address: 100 Timberhill Place, Current Mailing Address:
Suite 129
City: Chapel Hill City:
State: NC Zip: 27514 State: Zip:
Phone: [phone] Phone:
Email: mark©legacyrealpropertygroup.com Email:
Page 1 of 4

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: South Green Bluff, LLC Company/Organization:
Contact Person: Mark Moshier Contact Person:
Street Address: 100 Timberhill Place, Suite 129 Street Address:
Current Mailing Address: 100 Timberhill Place, Current Mailing Address:
Suite 129
City: Chapel Hill City:
State: NC Zip: 27514 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):
Mixed-use project featuring small commercial spaces on the ground floor with residential units
above. Project will have 3 buildings with a total of 57 residential units and 5,300 SF of commercial
space. The development also includes a dog park, an amenity area, and 88 parking spaces.
Plans Prepared by:
Name of Person/Firm: Ballentine Associates, PA
Contact Person: Dillon Smith
License Number: 042542
Mailing Address: 221 Providence Road
City: Chapel Hill State: NC Zip: 27514
Phone: [phone] Email: [e-mail]
Page 3 of 4

Certification and Signatures* u: st
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.
�_ _ _,_, 7 " Mark Moshier
Signature of Financially Responsible Party Type or Print Name Legibly
Principle \\;1 . �)r
Title or Authority Date
I, WALfiIEi fN AR ,4'1 o L 1 / �ie, a Notary Public of the County of D. 1k�L
hereby certify that 7vt/t RA< PO 0 SH I e-/ 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 7 Day of /\10 V E Pli g e2- _dL�
.-/-( (XL C,Ci- -- o S- - z101,
Signature of Notary YWILTERAHOLT,J.MyOommission Expires
11
NOTARY PUBLIC
ORANGE COUNTY,NC
SEAL Mr ComilsolooEo may--o - 24
Property Owner Acknowledgement`
I hereby acknowledge the above information and parties referenced herein have been granted
permission to conduct development activity on referenced property of which I own.
Mark Moshier
Signature of Property Owners Type or Print Name Legibly
%\ en •
_ Date
WAL
I, L At T /cc)7• `1-2• a Notary Public of the County of 0 N &
hereby certify that hq kA'K' Vn0 SN 1 r,-i2 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 7 Day of "\' 0\ t< ►4 5 - J z��
7,� ce
04_- b Z-ZC
Signature of Notary My Commission Expires
SEAL WALTER A HOLT,JR
NOTARY PUBLIC
ORANGE COUNTY,NC
My Commissbn EON u 4-aW-fib
Page 4 of 4