NCC243249_FRO Submitted_20241023

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or [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.
11/20/2023 * Please fill out all required fields
Date: Case Number:
Check all that apply: n Erosion Control Plan
n Stormwater Permit
❑ Stormwater Management Plan
General Submittal Information* Ill
Name of Project: Kiewit Infrastructure Maintenance Facilty - Mebane
Parcel ID Number (PIN): 9824898430 Planning Jurisdiction: Mebane
Size of Tract: 28.12 acres Area Disturbed 19.2 acres
Fees — Section Completed by Staff
Fee Amount
Erosion Control Plan Review $6 060
Required with Application
Land Disturbing Permit 23 040
Optional with Initial Application $ 7
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $�
Total $29,100
Approximate date land disturbance will begin: 5/12/2024
Contact Information*
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Kiewit Infrastructure South Co Name:
Street Address: 1550 Mike Fahey Street Street Address:
Current Mailing Address: 1550 Mike Fahey Street Current Mailing Address:
City: Omaha City:
State: N E Zip: 68102 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: Kiewit Infrastructure South Co Company/Organization:
Contact Person: Andrew Krieger Contact Person:
Street Address: 1550 Mike Fahey Street Street Address:
Current Mailing Address: 1550 Mike Fahey Street Current Mailing Address:
City: Omaha City:
State: NE Zip: 68102 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: CT Corporation System Name:
Street Address: 160 Mine Lake Ct Ste 200 Street Address:
Current Mailing Address: 160 Mine Lake Ct Ste 200 Current Mailing Address:
City: Raleigh City:
State: NC Zip: 27615 State: Zip:
Phone: [phone] Phone:
Email: n/a Email:
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Additional Project Information`
Project Description (detail the scope of the project and nature of land disturbance):
The project involves the expansion of an existing material laydown yard and a new laydown yard with a
26,000 SF building placed in the center. On the North and South extents of the main construction area
will be a wet pond that captures the runoff.
Plans Prepared by:
Name of Person/Firm: FEI
Contact Person: Andrew Christ
License Number: NC PE - 053670
Mailing Address: 8518 Triad Drive
City: Colfax State: NC 27
Zip: 235
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.
td/1?)at-u7re
A Y6 Si of Finan y Responsible Party Type or Print Name Leg
��'►rc�f o r 12 I oRa, / ac ova
Title or Authority Date
I, j e c c tikkc a Notary Public of the County of .N LA.CI 1 n
hereby certify that 141Ad re (Cr i e e r personally before me this day and
under oath acknowledged that this Applica "on 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 22VD y ofCfrnbpr 202-3
toa 1.6 (;"c77.
Sig t e of otary l My Commission Expires
A GENERAL NOTARY-State of Nebraska
4�7..� JESSICA MCGRAW
My Comm.Exp.June 22,2026
SEAL
Property Owner Acknowledgement*
I hereby acknowledge the above information and parties referenced herein have been granted
permission to conduct development activity on referenced prop^e-r'ty_of,which I own.
aZi
Signature of Property 9 ners Type or Print Name Legibly
/2./2-.X / 2•O d
Date
I, dt S SI CO a Notary Public of the County of\O v o ( Ct S
hereby certify that fkitC"e \ f►' r personally before meat'is 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 myhand and notarial seal, this 224a of �. ,c-eiriAQ r 2 023
Y
1 ` 1.0 lX ' - Z L9
Sig r re of No.ary My Commission Expires
SEAL
JERAL NOTARY-State of Nebraska
JESSICA MCGRAW
` My Comm Exp.June 22,2026
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