NCC231693_FRO Submitted_20230602

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or Q[[e-mail]
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: April 24, 2023 Case Number: ZCP-22-15
Check all that apply: n Erosion Control Plan
Stormwater Permit
n Stormwater Management Plan
General Submittal Information
Name of Project: Stanat's Place
Parcel ID Number (PIN): 9880028073 Planning Jurisdiction: Chapel Hill
Size of Tract: 8.16 acres Area Disturbed 7.46 acres
Fees — Section Completed by Staff
Fee Amount
Erosion Control Plan Review $1 ,11 9 $150 (7.46 Ac) = $1,119
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: Winter 2023
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Donald & Sylvia Stanat Name:
Street Address: 2516 Homestead Rd Street Address:
Chapel Hill, NC 27516
Current Mailing Address: Current Mailing Address:
2516 Homestead Rd
City: Chapel Hill City:
State: North Carolina Zip: 27516 State: Zip:
Phone: [phone] Phone:
Email: Email:
Page 1 of 4

Contract Purchaser (if applicable) (Use additional pages if necessary and attach to application):
Company/Organization: KB Home Raleigh Durham, Inc. Company/Organization:
Contact Person: Jimmy Gaskins Contact Person:
Street Address: 4506 S. Miami Blvd., Suite 100 Street Address:
Current Mailing Address: Current Mailing Address:
4506 S. Miami Blvd., Suite 100
City: Durham City:
State: North Carolina Zip: 27703 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
Person(s) or Firm(s) Financially Responsible for this Land Disturbing Activity:
Company/Organization: KB Home Raleigh Durham, Inc. Company/Organization:
Contact Person: Jimmy Gaskins Contact Person:
Street Address: 4506 S. Miami Blvd., Suite 100 Street Address:
Current Mailing Address: Current Mailing Address:
4506 S. Miami Blvd., Suite 100
City: Durham City:
State: North Carolina Zip: 27703 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: Geoff Reichelt Name:
Street Address: 4506 S. Miami Blvd., Suite 100 Street Address:
Current Mailing Address: 4506 S. Miami Blvd., Suite 100 Current Mailing Address:
City: Durham City:
State: North Carolina Zip: 27703 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
Page 2 of 4

Additional Project Information
Project Description (detail the scope of the project and nature of land disturbance):
Residential subdivision proposing 47 single-family homes and public infrastructure to support
development. Public infrastructure include storm, water, sewer, and streets.
Plans Prepared by:
Name of Person/Firm: Advanced Civil Design, Inc.
Contact Person: Cameron M. Rice, PE
License Number: 028924
Mailing Address: 51 Kilmayne Drive, Suite 102
City: Cary State: North Carolina Zip: 27511
Phone: [phone] Email: [e-mail]
Page 3 of 4

Certification and Signatures
Signature and Witness: The above information is true and correct to the best of my knowledge and
belief a was provided by me while under oath.
Jimmy Gaskins
S' natGre of Financially Responsible Party Type or Print Name Legibly
Vice President of Land Acquisition 9- /1 -a3
Title or Authority Date
I, Lc,,,\ ' ka\VA.1k, a Notary Public of the County of J011\,5.,an"
hereby certify that Jimmy Gaskins 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 \,ek\ 'Day of car.\ , t () 3
Signature of N ERIN N POLLOCK My Commission Expires
NOTARY PUBLIC
Johnston County
SEAL North Carolina
My Commission Expires June 17,2024
Property Owner Acknowledgement 1.111"41.1111."
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.
Signature of Property Owners Type or Print Name Legibly
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
Signature of Notary My Commission Expires
SEAL
Page 4 of 4

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.
Jimmy Gaskins
Signature of Financially Responsible Party Type or Print Name Legibly
Vice President of Land Acquisition
Title or Authority Date
I, a Notary Public of the County of
hereby certify that Jimmy Gaskins 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
Signature of Notary My Commission Expires
SEAL
Property Owner Acknowledgement
I hereby acknowledge the above information and parties referenced herein have been granted
permission to conduct development activity on referenced property Lof which I own. _(
Signature of Property Owners Type or Print Nam `Legibly
4J2.tj23
Date
I, , a Nota Public of the County of �.✓� r-2_
hereby certify that Oo �J d a„ J 5� v - b7D ni 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 a 1 Day of Pt 1 1 ,
ao aW
k
Signature My Commission Expires
THERESA LEPORE
Notary Public
SEAL Wake County,North Carolina
My Commission Expires
July 10,2024
Page 4 of 4