NCC231049_FRO Submitted_20230417

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DEVELOPMENT OWNERSHIP FORM FORAN
(828)[e-mail] EROSION CONTROL PERMIT
www.buncombecounty.org/planning
INSTRUCTIONS:All sections must be completed.Section E must be CASE NUMBER:
completed in the presence of a Notary Public.
PIN(Numbers): 9656-32-8774,9656-32-3939 Project Name' Busbee Phase 1A-Age Targeted E; cmmn
i
Latitude: 35.5203 Longitude: -82.5189 Amount of fee enclosed:5 5,643.75
Project Location-13ighway/Street- Sweeten Creek Road US 25A
4 Proposed Use: ❑Single Family Residence XMulti-Family ❑Vacation Rental ❑CommerciaUlndustriaUOther ❑Other
Proposed Disturbed Area(Include offsite borrow and waste areas): 10.75 acres)
B.
Section 26-228(b)of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Erosion control plans shall be
accompanied by a notarized 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 undersignt:d states that he/she is the person
financially responsible for land disturbing activity described in this application and acknowledges receipt Of Ctapy 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: FDG Sweeten Creek Holdings,LLC Name of Applicant: Michael Moran
Mailing Address: PO Box 6566 Columbus,GA 31917
Street address: 1100 Brookstone Centre Parkway Columbus,GA 31904
E-mail address: [e-mail]
Telephone: Cell: 470-428-0226 Fax:
Name of Landowner(s)of Record: FDG Sweeten Creek Holdings,LLC
Mailing Address: 1100 Brookestone Centre Parkway Columbus,GA 31904
Recorded in Deed Book No: 6169 page: 1215
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: CT Corporation System
Mailing Address: 160 Mine Lake Ct,Ste 200 Raleigh,NC 27615
E-mail address:
Telephone Cell' Fax:
Signature: Date:
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 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.The above information is true and correct to the best of my knowledge and belief and was
provided by a while under oath.
Name: 1 0 Z s• vJ 011 Title: S V p i G F o
Signature: Date:- S-14—2.t
1, a Notary Public for the County of nmmmcle
State of C�C�C�i1 I hereby certify that ersnnally
appeared before me this y and under oath acknowledged that the above form w s executed by him and is correct to the best of his
knowledge and belief
Witness my 4and•and ra.6 this day of 20 �Q
��'•- ?r err '
I - I"XP c :� . My Commission li spire.
[lF> [ClII
GO Pcmiit No C#isck No:.
MAS(sirM.?.k 11=6ved by: Date lsmwc I
The CSrtn j of Bimeombg doea nor discriminate on the basis 6fd1sability in the admission or access to,or treatment or employment in,
its progl"..or activii'i0$-Kegliesri far appropriate auxiliary aids and services,when necessary to offer a person with a disability an
equal appprlriniti to pgficW.te in or enjoy the benefits of County services,programs, or activities, may be made by contacting
Buncombe(sounry Erosfgn Control,[phone]. Buncombe County's TDD number is(828)250-4001.