NCC222888_FRO Submitted_20220815

BUNCOMBE COUNTY
PLANNING & DEVELOPMENT
(828) 2504830 - [e-mail]
www.buncombecounty.org/planning
INSTRUCTIONS: All sections must be completed. Section D must be
completed in the presence of a Notary Public.
Project Name: North Buncombe Middle School - Softball Field
PIN (Numbers): 9743-44-1042
Latitude: 35.713537 Longitude:-82.556553
Project Location - Highway/Street: N Buncombe School Road
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR A
STORMWATER PERMIT
CASE NUMBER:
Amount of fee enclosed: S 1265.25
Proposed Use: ❑ Single Family Residence ❑ Multi -Family ❑ Vacation Rental 8 Commercial/Industrial ❑ Other
Proposed Disturbed Area (Include offsite borrow and waste areas): 2.41 acre(s)
Name of Applicant: Buncombe County Schools
Applicant's Point of Contact (for official correspondence): Tim Fierle
Mailing Address: 175 Bingham Road, Asheville, NC 28802
Street address: 175 Bingham Road, Asheville, NC 28802
E-mail address: [e-mail]
Telephone: [phone]
Cell:
Name of Landowner(s) of Record: Buncombe County Board of Education
Mailing Address: 175 Bingham Road, Asheville, NC 28802
Recorded in Deed Book No: 717
Name of Landowner(s) of Record:
Mailing Address:
Recorded in Deed Book No:
Page: 626
Page:
State of Business Registration (if'applicable):
Fax:
Note: If'applicant is not landowner of record, provide executed Buncombe County Stormwater Agent Authorization Form
I, 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 installation, operation, and maintenance of the stormwater controls until ownership
is conveyed for the above referenced project. I acknowledge receipt of a copy of the County of Buncombe Stormwater Management
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. The above information is true and correct to the best of my knowledge and belief and
was provided by me while under oath.
Financially R ible Party: B
A
Signatu-re���,
Name: 1 l "
be County Board of Education
Dale: -7 t&Z 2 /j
Title:A�_ [ J�-
f } i m e� (--• N�a-�%P S a Notary Public for the County of RL)n C rn6(_
State of r1CL hereby certify that _imo4 [(— personally
appeared before me this day and under oath acknowledged that the above form was executed by him and is correct to the best of his
kn owl edgearl liel i ef.
Witness my hand, and seal, this_ 1t" day of J U I U 720 a a
Notary
My Commission Expires i� as a5
- 4
OFFICE Review Fee: $ . Permit No.: Check No:
USE Date Paid: Received by: Date Issued:
The County of'Buncombe does not discriminate on the basis of disability in the admission or access to, or treatment or employment in,
its programs or activities. Requests for appropriate auxiliary aids and services, when necessary to offer a person with a disability an
equal opportunity to participate in or enjoy the benefits of County services, programs, or activities, may be made by contacting
Buncombe County Erosion Control, [phone]. Buncombe County's TDD number is (828) 50-4001.