NCC242345_FRO Submitted_20240802

"` - 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.
06/19/2024 * Please fill out all required fields
Date: Case Number:
Check all that apply: V Erosion Control Plan
I� 1 Stormwater Permit
✓ Stormwater Management Plan
General Submittal Information*
Name of Project: Williams Glen
Parcel ID Number (PIN): 9883098108 Planning Jurisdiction: Orange County
Size of Tract: 28.17 acres Area Disturbed 5.36 acres
Fees - Section Completed by Staff
Fee Amount
Erosion Control Plan Review 1908
Required with Application $
Land Disturbing Permit 3,816
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only $2,500
Required with Application
Total $8,224
Approximate date land disturbance will begin: asap
Contact Information*
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Lawrence Road Partners, LLC Name:
Street Address: Street Address:
320 Executive Court
Current Mailing Address: _ Current Mailing Address:
320 Executive Court
City: Hillsborough City:
State: NC Zip: 27278 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] 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: Lawrence Road Partners, LLC Company/Organization:
Contact Person: James W Parker Contact Person:
Street Address: Street Address:
320 Executive Court
Current Mailing Address: Current Mailing Address:
320 Executive Court
City: Hillsborough City:
State: NC Zip: 27278 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:
Page 2 of 4

Additional Project Information*
Project Description (detail the scope of the project and nature of land disturbance):
15 lot subdivision
Plans Prepared by:
Name of Person/Firm: EarthCentric Engineering Inc.
Contact Person: Charles P. Koch
License Number: NCPE 22634
Mailing Address: 204 West Clay Street
City: Mebane State: NC Zip: 27302
Phone: [phone] Email: Phil.Koch©EarthCentric.com
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.
coal(Ai Scott W. Ashton, Lawrence Rd Partners, LLC
Signature of Financially Responsible Party Type or Print Name Legibly
Manager 940 2 Y
Title or Authority Date
I, cl:D A a Notary Public of the County of 01_0 zcgo
hereby certify that Scott W. Ashton 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
RpyR fljbiIity was executed by him or her.
,HAt.,1/
" d and notarial seal, this /9 Day of June 2024
0; 1 °mm3E/pit _ 47 A- /7 a 3 to
gnatur of otary My Commission Expires
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.
�v C2 � Scott W. Ashton, Lawrence Rd Partners, LLC
Signature of Property Owners Type or Print Name Legibly
/i9/eoZy
l Date
I, c-r� ? - A T.�e � � a Notary Public of the County of CQr~a 7
hereby certify that Scott W. Ashton personally before me tht 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.
,.0 r, s'royhand and notarial seal, this / 9 Day of June 2024
CT. 01ARJ-
c m.Expires acee //
o MY ° ��'
_Sjaras.ceMotary My Commission Expires
Page 4 of 4