NCC232848_FRO Submitted_20230922

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.
20 -3Date: l Case Number:
Check all that apply: Erosion Control Plan
Stormwater Permit
n Stormwater Management Plan
General Submittal Information 1
Name of Project: �r V\(� Wvn Q, / —►^.� �.-�
Parcel ID Number c
m1� ` 1
(PIN): � � 6 Planning Jurisdiction: �1\Sb(.YOAKill
Size of Tract: " •1 -� acres Area Disturbed '3.1(-1 acres
Fees - Section Completed by Staff
Fee Amount
Erosion Control Plan Review ,00
Required with Application $
Land Disturbing Permit
Optional with Initial Application $ +� ��
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $
Total $ 3430 . 00
Approximate date land disturbance will begin: lQ4'. ` 'L023
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
`
Name:1)R --ctfR 1VT • n�, Name:
Street Address: c 2 P rC 1 e✓1&I \r W4-1Street Address:
Pc-
Current Current Mailing Address: Cc- line 0.5 0.191LQ-)Current Mailing Address:
City: Mlja\SOke, City:
State: INC Zip: a1S(00 State: Zip:
Phone: vlicl . c -\L . 1 Phone:
Email: � J�,IP.r��Ir'V'\ k l-��C(V1 Email:
—f"
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�A Responsible for this Land Disturbing Activity:
Company/Organization: C(RDC1 ,\ '�,' Company/Organization:
�sContact Person: \Cc `"` Or Contact Person:
Street Address: ACO A2i1aL` Uen\CX- PV,V1 Street Address:
Current Mailing Address: &A0\fi 0.S 03001-12- Current Mailing Address:
City:\JWASV\\V- City:
State: N.C., n` Zip: lgt00 State: Zip:
Phone: CIA.DAS• to14 1 Phone:
Email: Jam`v!e,i-- & A' 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: CT C,bf p0 D(\ � C, Y✓1 Name:
Str et Address: \1DO MI1 n,_, R • Street Address:
u aon
Current Mailing Address: (SQXYV) Current Mailing Address:
City: 1- v1g111 City:
I VC
State: ' Zip: a-1 416 State: Zip:
Phone: a 1 y""l 7 9;Q:so Phone:
Email: 111 Email:
Page 2 of 4

Additional Project Information
Project Description (detail the scope of the project and nature of land disturbance):
1- XN,1 Attie,1 P n;- c;v\s -cr„m\' lvt cons tyn c.AhwY, .
Plans Prepared by:
Name of Person/Firm: ,\)\(,{s&Qn(1S
Contact Person: Bak& TRIA;(\e,
License Number:a'2.1SL+ 1,
Mailing Address: c s N ' P.I/'�rt\O.Y)?4v '-j
City:Du4r-hk.hn /nlState: N C, Zip: pC l ► l2
Phone: O1 \ 9�5 7 . (UISS Email: '(hI r vt, -\- t 1attka, nKc,o•
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.
Sitfil ature of Finan i Ily Responsible Party Type or Print Nanie Legibly
g Y
Y. Sionyu Ae r Cot r pVI c n ct Speuaisa-5 Su7\- cS Q_oe
Titl or A Date
I, u.ny% ority a Notary Public of the County of
hereby certify t t MCA Q personally before me this day and
under oath acknowledged that this Ap9lication 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 bay of 1-P ' . `?.o
Signature o ary My Com ission Expires
CHRISTY J WHICHARD
NOTARY PUBLIC
SEAL Pitt County,North Carolina
My Commission Expires July 29,2025
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.
Signature of Property Owners Type or Print Name Legibly
Date
I, 0M\Sl : 0114 a Notary Public of the County of
hereby certif hat \ > personally before me this day and
under oath ac nowledged that this Ap lication 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.p
•
Witness my hand and notarial seal, this*)Day Day of .iWJ ''/ 2-1S2-3
b--Ao 41 3AAVAZq )70-25
Signs ur otary My Commission Expires
SEAL
CHRISTY J WHICHARD
NOTARY PUBLIC
Pitt County,North Carolina
My Commission Expires July 29,2025 Page 4 of 4