NCC243772_FRO Submitted_20241211

"111001011111=--- Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or planninaapps(cDorandecountvnc.pov
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.
*Please fill out all required fields
Date*: July 9 2024 Case Number:
Check all that apply*: 0 Erosion Control Plan
❑Stormwater Permit
❑Stormwater Management Plan
General Submittal Information*
Name of Project: Hillmont
Parcel ID Number (PIN): See final page for all PIN numbers Planning Jurisdiction: Chapel Hill
Size of Tract: 34.84 acres Area Disturbed 27.67 acres
Review Fee Payment* - To be completed by applicant
❑ Credit Card (additional 3% fee) Q Check
Note: A 2% technology fee will be applied to the permit fee as illustrated below.
Review Fee — To be completed by staff
Fee Amount
Erosion Control Plan Review
Required with Application $8,601.00
Land Disturbing Permit
Optional with Initial Application $
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $
Total $8,601.00
Technology fee (2%) $172.02
Credit Card fee (3%)
If applicable $
Total $8773.02
Approximate date land disturbance will begin:
Contact Information*
Landowner(s) of Record* Use additional pages if necessary and attach to application
Name: NR Hillmont Property Owner LP Name:
Street Address: 3015 Carrington Mill Blvd, Ste 460 Street Address:
Current Mailing Address: 3015 Carrington Mill Blvd, Current Mailing Address:
Ste 460
City: Morrisville City:
Page 1 of 4
Revised 5/14/2024

State: NC Zip: 27560 State: _ Zip:
Phone: [phone] Phone:
Email: Email:
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:NR Hillmont Property Owner LP?Company/Organization:
Contact Person: Adam Golden Contact Person:
Street Address: 3015 Carrington Mill Blvd, Ste 460 Street Address:
Current Mailing Address: 3015 Carrington Mill Blvd, Current Mailing Address:
Ste 460
City: Morrisville City:
State: NC Zip: 27560 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
Registered Agent (if any)for the Person(s) or Financially Responsible Party*
— A North Carolina agent is required if the applicant is not a resident of North Carolina.
— All firms and companies shall complete and identify agent.
Name: Corporation Service Company Name:
Street Address: 2626 Glenwood Ave Ste 550 Street Address:
Current Mailing Address: Current Mailing Address:
2626 Glenwood Ave Ste 550
City: Raleigh City:
State: NC Zip: 27608 State: Zip:
Phone: [phone] _ Phone:
Email: [e-mail] Email:
Page 2 of 4
Revised 5/14/2024

Consent to Receive Electronic Communication
As the Financially Responsible Party, I consent to receiving notifications regarding this project through
electronic communication.
Email: [e-mail] Initials:
I agree to provide any updated email addresses as necessary to ensure consistent communication is
maintained between myself and Orange County Sedimentation and Erosion Control. Electronic
notifications may include Plans Review Comments, Approvals and Disapprovals.
The Financial Responsible Party is responsible for the distribution of correspondence from Orange
County to other pertinent parties.
Additional Project Information*
Project Description* Detail the scope of the project and nature of land disturbance. Use additional pages if
necessary and attach to application.
Located near the intersection of Barbee Chapel Road and Pearl Lane in Chapel Hill, Durham County, North Carolina is
the proposed development currently known as Hillmont. Future development on this 34.84-acre site will consist of multi-
family residential development, along with roadways, sidewalks, and other associated infrastructure. Six stormwater control
measures(SCMs)are proposed with the total build out of this project. This application only includes design and disturbance
for demolition and grading of early-stage construction work, considered as Part 1
Plans Prepared by*
Name of Person/Firm: McAdams
Contact Person: Lee Weaver, PE
License Number: 37994
Mailing Address: 621 Hillsborough Street, Ste 500
City: Raleigh State: NC Zip: 27603
Phone: [phone] Email: [e-mail]
Page 3 of 4
Revised 5/14/2024

Certification and Signatures*
Signature and Witness: The above information is true and correct to the best of my knowledge and
nb�ef and was provided by me while under th.
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-1 Signa� of� ally Responsible Party Type or Print Name Legibly
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Title or Aut orit Date
I, S P` ' U` /1ti \ a Notary Public of the County of 10 ----(�
hereby certify that p 4 VVV ,"'C' ,/,‘.'`{, L\-- 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
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Property Owner AcknowledgtfjUN
I hereby acknowledge the above irifdt tiatidt and parties referenced herein have been granted
permission to conduct development activity on referenced property of which I own.
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Date
I, ` -Z '� a Notary Public of the County of \A)A ,��J
hereby certify that ; ANC.. 7l, iV'--, 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 Da of f ?v9-4-
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-;,�.'`•-31/2021,•'y?, Page 4 of 4
Revised 5/14/2024

PIN Numbers:
9798-71-8728, 9798-81-1816, 9798-82-6083, 9798-82-2139, 9798-82-6522, 9798-82-9499,
9798-92-0839, 9798-93-2025