NCC232464_FRO Submitted_20230816

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROI.iNA 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: 10 APR 23 Case Number:
Check all that apply: ✓ Erosion Control Plan
✓ Stormwater Permit
Stormwater Management Plan
General Submittal Information
Name of Project: Montgomery Estates
Parcel ID Number (PIN): 9862507727 Planning Jurisdiction: Orange County
Size of Tract: 66.76 acres Area Disturbed 9.5 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:
Contact Information
Landowner(s) of Record (Use additional pages if necessary and attach to application):
Name: Montgomery Farm Ventures, LLC Name:
Street Address: 2840 Plaza Place Street Address:
St. 100
Current Mailing Address: Same Current Mailing Address:
City: Raleigh City:
State: NC Zip: 27612 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: Montgomery Farm Ventures, LLC Company/Organization:
Contact Person: Bobby Medlin Contact Person:
Street Address: 2840 Plaza Place Street Address:
Suite 100
Current Mailing Address: Same Current Mailing Address:
City: Raleigh City:
State: NC Zip: 27612 State: Zip:
Phone: Same Phone:
Email: Same 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):
Montgomery Estates is a proposal for the subdivision of an existing 66.76 acre property into 10
individual parcels. (3) Three new private, Class A roads (18' pavement width, 50' R/W) are proposed as
a part of this project: Montgomery Estates Road, Olive Way, and Coco Lane. Dry utility services (electric
and telecommunications) will also be run to each of the proposed parcels. Approximately 9.48 Acres will
be disturbed by construction.
Erosion control measures for this site have been designed in accordance with NCDENR Erosion and
Sediment Control Planning and Design Manual (dated June 1 , 2006, revised March 2009). An erosion
control report with supporting calculations is included with this application.
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]
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 provide y me while under oath.
, c, PA- L o ti\G n
Signature of i anciaily " sponsible Party Type or Print Name Legibly
Titl,e or Authority 1" Date �, „
I, ak (kn.. �i Yt(^),, \" (i n a Notary Public of the County of uIl
CL
hereby ertify that Or �u C ltG 1Q i personally before me this day and
under oath acknowledged that this Applicat'on for Erosion Control Plan Approval, Stormwater
Management Plan Approval, and Land Disturbing Permit/ Statement of Ownership and Financial R
Responsibility was executed by him or her. •
Witness my hand and notarial seal, this Day of WSJ/ , Oan •
frA, VP, clina_6n \ 0
• . ••i NE BLISS BINGHAM
Signature J My Commission Expires
NOTARY PUBLIC
Vance County
North Carolina
SEAL My Commission Expires August 9,2026
Property Owner Acknowledgement
I hereby acknowledge the above information and parties referenced herein have been granted
permission to conductdevelopment-activity on referenced property of which I own.
;"
Si ature o roperty- ers Type or Print Name Legibly
Date 4
I, Lei C 5 ?l)tflha Notary Public of the County of L
hereby certify that mLLLQ f( i0tt 1 personally before me this day and
under oath acknowledged that this Applicat'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. {�(�f I �/ A03Witness my hand and notarial seal, this ) l 1 Day of l Lh ,
VI* nQ- 1())161) biocrumg rY Si nature of ota My Commission Expires
SEAL
LEIGH ANNE BLISS BINGHAM
NOTARY PUBLIC
Vance County Page 4 of 4
North Carolina
My Commission Expires August 9,2025