NCC243618_FRO Submitted_20241121

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH H 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.
Date: 9/20/2023 Case Number:
Check all that apply: Erosion Control Plan
Stormwater Permit
Stormwater Management Plan
General Submittal Information
Name of Project: Gimghoul Castle Building Renovation and Patio Addition
Parcel ID Number (PIN): 9788-96-2765 Planning Jurisdiction: Chapel Hill
Size of Tract: 2.15 acres Area Disturbed 0.52 acres
Fees — Section Completed by Staff
Fee Amount
Erosion Control Plan Review
Required with Application $
Land Disturbing Permit
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $
Total $
Approximate date land disturbance will begin: March 2024
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Gimghoul Corporation Name:
Street Address: 742 Gimghoul Road Street Address:
Chapel Hill, NC
Current Mailing Address: PO Box 3670 Current Mailing Address:
City: Chapel Hill City:
State: NC Zip: 27515 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] 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: Gimghoul Corporation Company/Organization:
Contact Person: Craig Ward Contact Person:
Street Address: 3 Hastings Square Street Address:
Durham, NC 27707
Current Mailing Address: 3 Hastings Square Current Mailing Address:
City: Durham City:
State: NC Zip: 27707 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):
Building and patio addition with new utility extensions, H/C parking and stromwater control measure.
Plans Prepared by:
Name of Person/Firm: Civil Consultants, Inc
Contact Person: Andrew Jones
License Number: 045307
Mailing Address: 3708 Lyckan Parkway Suite 201
City: Durham State: NC Zip: 27707
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.
Gimghoul Corporation R. Sterling Kelly Ill
Signature of Financial! Res sible arty Type or Print Name Legibly
Director 9/20/2023
Title or Aut ority Date
I, - c L . Lo \\\ a Notary Public of the County of k1�2o
hereby c� ci J
ify that R. Sterling Kelly III 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 4er43 " Q 04-3
Signa reo1. IN,. _ � 16 �� b
g y,�s JODY C. LONG LL My Commission Expires
�` Notary Public
ki =�� North Carolina
SEAL '' GuilfordCounty
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.
R. Sterling Kelly Ill
Sign tur f Pr rty Own s Type or Print Name Legibly
9/20/2023
30, ,,,
DateI, C . Lor UU��,' a Notary Public of the County of �U\\ eD
hereby certi that R. Sterling Kelly Ill 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, thiso0 Day of ok.n str, cpa,.5
Signs - •' Notary My Commission Expires
JODY C. LONGWILL
.r, `4d Notary Public
SEAL "i'`< North Carolina
we �%
Guilford County
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