NCC220385_FRO Submitted_20220120

BUNCOMBE COUNTY
[phone] - Planninglnfo@BuncombeCounty otg
www.buncombecountyorglplanning
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
INSTRUCTIONS: All sections must be completed. Section E must be
completed in the presence of Notary Public. CASE NUMBER:
PIN (Numbers}: 9643-75-9542 Project Name: Centre at Airport Road (Formerly Alan's JeKelry& Paun1
I.atitnde; 35.444R N Longitude: 82,5331 W Amount of fee enclosed: S
Project Location - Highway/Street: 1_ Brian Road
Proposed Use: Single Family Residence Muni -Faintly 6-cation Rental X CommerciallMdustriall0ther 0 Other
Proposed Disturbed Area (include offsile borrow and waste areas): 1.5 acre(s)
Section 26-228(b) of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Erosion control plans shall be
accompanied by a notartzed statement of financial responsibility and ownership". This statement shall be signed by the person
financially responsible for the land disturbing activity or his attorney in fact. The undersigned states that he/she is the person
financially responsible for land disturbing activity described in this application and acknowledges receipt of a copy of the County of
Buncombe Soil Erosion and Sedimentation Control Ordinance and that he/she has thereby been advised of the requirements therein as
well as the penalties and resources available to the County in the event of violation of the Ordinance, including revocation of the Land
Disturbing Permit and all building permits issued in connection with the project covered by the application.
Name of Business: Band F Airport. LLC _ _ Name of Applicant: Greg Edney
Mailing Address: 59 Fairway Falls Road Mills River NC 29759
Street address: 59 Fairway Falls Road- Mills River, NC 28759
F-mail address: g �dneev&mailcom
Telephone: [phone]Od7 Cell _ Fax: _
Name of Landowner(s) of Record: B and E Airport I,LC _
Mailing Address: 59 Fairway Falls Road, Mills River NC 28759
Recorded in Deed Boot; No:
Section 26-228(b) of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "If the person financially responsible
is not a resident of North Carolina, a North Carolina agent must be designated in the statement for the purpose of receiving notice of
compliance or non-compliance with the plan, the Act, this ordinance, or rules or orders adopted or issued pursuant to this ordinance."
The person noted below is the designated North Carolina agent and is duly authorized by the financially responsible person to accept
and convey correspondence regarding the aforementioned project,
Name of Agent:
Mailing Address:
h-mail address:
Celephotre: Cell:
Signature: Date:
Fax:
1, the undersigned, attest that I am the financially responsible party or an authorized representative with signatory authority for the
financially responsible party, responsible for the construction activities and maintenance of the site until ownership is completed for the
above referenced project. I acknowledge receipt of a copy of the County of Buncombe Soil Erosion and Sedimentation Control
Ordinance and have thereby been advised of the requirements therein as well as the penalties and resources available to the County in
the event of violation of the Ordinance. "Ire above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. �A
Name: i Edney. 'Title:
Signature: Date:
1 /'. /)7/ G - ! �%DllnlSQi✓ a o Public for the County of QC% AfLU in ip-, ��-
State of N hereby certifv thatR �C �O/✓Ey% _personally
appeared before me this day and under oath acknowledged that the above form w executed by him and is corrrt�heeWknowledge and belief. LWitness my hand and seal, this 7'�day of 't20ZTAR VY
Notary My C'n fission r-.xpires � 7- _7�vetgx
OFFICE Review Fee: S_.� _ emtit No.: ..__ Check No: t'r
(/SE Date Paid: ivied by: _ .__ _ Date Issued: �1 A—�%.��-.-{-G ���
77te County of Buncombe does nor discriminate on the b is of disabil' in the admission or access to, or treatment t �ytn r > �\,y �'
its programs or activities. Requests for appropriate atccilia nd services, when necessary ro offer a person with �r� t%I
equal opportunity to participate in or enjoy the benefits of County services. programs, or activities, may be made by cot`trcy"itiig
Buncombe Cou ntv Erosion Control, [phone]. Buncombe County's TDU number is [phone].