NCC240367_FRO Submitted_20240209

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or planningapps at7orangecountync.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: 25 Aug 23 Case Number:
Check all that apply: ✓ Erosion Control Plan
Stormwater Permit
Stormwater Management Plan
General Submittal Information
Name of Project: Jade Creek
Parcel ID Number (PIN): 9860-81-0089 Planning Jurisdiction: Carrboro
Size of Tract: 36.70 acres Area Disturbed 18.82 acres
Fees — Section Completed by Staff
Fee Amount
Erosion Control Plan Review $5,946
Required with Application
Land Disturbing Permit 22584
,
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only N/A
Required with Application
Total $28,530
Approximate date land disturbance will begin: January 2024
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Blocker Properties, LLC Name:
Street Address: 8620 Lake Hogan Farms Street Address:
Current Mailing Address: Same Current Mailing Address:
City: Chapel Hill City:
State: NC Zip: 27516 State: Zip:
Phone: Phone:
Email: Email:
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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: KB Home Raleigh-Durham Inc. Company/Organization:
Contact Person: R. Scott Johnson Contact Person:
Street Address: 4506 S. Miami Blvd. #100 Street Address:
Current Mailing Address: Same Current Mailing Address:
City: Durham City:
State: NC 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: Name:
Street Address: Street Address:
Current Mailing Address: Current Mailing Address:
City: City:
State: Zip: State: Zip:
Phone: Phone:
Email: Email:
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Additional Project Information
Project Description (detail the scope of the project and nature of land disturbance):
Jade Creek is a residential subdivision proposed by KB Home consisting of 72-single family lots,
approximately 2,400 linear feet of public streets, and recreational amenities. The site is approximately
36.7 acres in size and is located along the east side of Old NC 86 in the Town of Carrboro, NC.
Approximately 18.82 acres of land will be disturbed as a part of this development.
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]
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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.
R. Scott Johnson
Signature of inanci II Responsible Party Type or Print Name Legibly
Sr. Director of Development _ Zct _ Z
Title or Authority Date
I, RAC he. \ Cu v ci I e a/ a Notary Public of the County of U\JrI ke—
hereby certify that R. 5c.o f1 Johnson 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.
fh
2
Witness my hand and notarial seal, this - Day of 61)30 , 2023
AttcD4 C 'J2 -A April
11, 2 0l.7
Signature of NQtanc My Commission Expires
RACHEL CAVALEAR
Notary Public, North Carolina
Wake County
SEAL My Commission Expires
April 19,2027
Prope Owner RcKnowiiedgement
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, 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
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