NCC232356_FRO Submitted_20230808

Noilftwo Orange County Planning & Inspections Department
r'1n A t. Ir"C r-r m IA ITN 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
919-245-2575 or plannIngapps(@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: 6/26/23 Case Number:
Check all that apply: n Erosion Control Plan
n Stormwater Permit
n Stormwater Management Plan
General Submittal Information
Name of Project: Rales Property
Parcel ID Number (PIN): 9892535052 Planning Jurisdiction: Orange County
Size of Tract: 17.86 acres Area Disturbed 4.25 acres
Fees - Section Completed by Staff
Fee Amount
Erosion Control Plan Review 660.00
Required with Application $
Land Disturbing Permit
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only 300 00
Required with Application $
Total $960.00
Approximate date land disturbance will begin: July 17, 2023
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application)
Name: Alexandra Funk Rales Name: Amanda Funk Rales
Street Address: 609 Virginia Avenue Street Address: 609 Virginia Avenue
Raleigh, NC 27604 Raleigh, NC 27604
Current Mailing Address: 609 Virginia Avenu Current Mailing Address: 609 Virginia AvenuE
Raleigh, NC 27604
City: Raleigh City: Raleigh
State: NC Zip: 27604 State: NC Zip: 27604
Phone: Phone:
Email: 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: Company/Organization:
Contact Person: Alexandra Funk Rales Contact Person: Amanda Funk Rales
Street Address: 609 Virginia Avenue Street Address: 609 Virginia Avenue
Raleigh, NC 27604 Raleigh, NC 27604
Current Mailing Address: 609 Virginia Avenue Current Mailing Address: 609 Virginia Avenue
City: Raleigh City: Raleigh
State: NC Zip: 27604 State: NC Zip: 27604
Phone: Phone: [phone]
Email: Email: [e-mail]
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):
Construction of single family residence with driveway and onsite utilities
Plans Prepared by:
Name of Person/Firm: Diehl & Phillips, P.A.
Contact Person: Alan Keith, P.E.
License Number: 13371
Mailing Address: 1500 Piney Plains Road Suite 200
City: Cary State: NC Zip: 27518
Phone: [phone] x 102 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 and was provided by me while under oath AL-Wwairoi Fwvt k Wai4 S
'/
Swit ANti1lJ P, et)N t: g_Pk L-rcS
signet re of Financially Responsible Party Type or Print Name Legibly
Owners (0 / q/020023
Title or Authority Date
I, 'had 13. Trqce. a Notary Public of the County of Wale_
hereby certify that AkxarArr; Fi,-.k 9a1es r Anna lo. ink gales 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.
\1 /it�eas,v)y�hand and notarial seal, this q Day of Tune , a0O73
, o
g . JorL.'%
T. .)eeQm her Ca 02 0.25
nature . etary My Commission Expires
PitiertV p 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.
ft owi a� > k (.e S
� -� A LE A( 1,rP ex w J lc R
Signature of Property Owners Type or Print Name Legibly
6/a/020.2'3
Date
I, ('haci '3. ,T ce a Notary Public of the County of Wake
hereby certify that /41exa,drA rink Rai,: • Arrmda r- ,,k Vales 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 q Day of J.-IAA e 02062 3
.�� en b 6 a0as
i S i to y ,Notary My Commission Expires
O• PRY
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