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HomeMy WebLinkAboutNCC221345_FRO Submitted_202204060RANGE 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 (919)245-2575 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 Ibarnes@familyfarecstores.com 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 Ibarnes@familyfarecstores.com 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 chuffine08@gmail.com 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 6 2 o d ltC'►�_� —I.Y Com t ion Expires Page 4