NCC241504_FRO Submitted_20240517

,� "aE` BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
`` PLANNING & DEVELOPMENT OWNERSHIP FORM FOR AN
'- / (828)[e-mail]
k www.buncombecounty.orglplanning EROSION CONTROL PERMIT
INSTRUCTIONS:All sections must be completed.Section E must be CASE NUMBER:
completed in the presence of a Notary Public.
A. Existing Property Information
PIN(Numbers): 9629-16-2395,9629-16-6737 Project Name: Secured Sen-Storage at 466
Latitude: 35.610217°N Longitude: 82.628373°W Amount of fee enclosed:$ 682.50
Project Location-Highway/Street: 466 New Leicester Hwy
Proposed Use: o Single Family Residence o Multi-Family o Vacation Rental X Commercial/Industrial/Other o Other
Proposed Disturbed Area(Include offsite borrow and waste areas): 1.3 acre(s)
B. Contact Information—Financially Responsible Person
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 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: Azalea Management&Leasing,Inc. Name of Applicant: Carl Ricker
Mailing Address: 1300 Tunnel Road,Asheville,NC 28805
Street address: 1300 Tunnel Road,Asheville,NC 28805
E-mail address: [e-mail]
Telephone: [phone] Cell: Fax:
C. Landowner(s)of Record
Name of Landowner(s)of Record: Azalea Limited Partnership
Mailing Address: 1300 Tunnel Road,Asheville,NC 28805
Recorded in Deed Book No: 2033 Page: 0189
D. Contact Information—North Carolina Agent(IfApplicable)
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:
E-mail address:
Telephone: Cell: Fax:
Signature: Date:
E. Certification
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 me while under oath.
Name: Carl Ricker t - Title: Secretary
Signature: ...�» Date: Jt"ICI*010:14
I, Shire V. L A'kwwDA/ ,a No is for the County of 54.fU.CO t*6-G ,
State of 7)ot'YL 1.&ro1I*A.4.... L. !{hereby certify that Ca.r L •'Rick-
1' 1 U—r: personally
appeared b fore m tstc�lal/.nfler oath acknowledged that the above form was executed by him and is correct to the best of his
knowledge and k`$ai E Y'
Witness m\�tiiie al,this/ day of A 4 20 O�T
N 0 ]•q R J' Zotak Y.—
/ O�CGGtJ d•d 7`�'
�m A idly Commission Expires /0 re2/' Pe 4
OFFICE i• view Fee: 1 C+ Permit No.: Check No:
USE le aid: N' Received by: Date Issued: i
The County of Irdr`c k i )�xt ate on the basis of disability in the admission or access to,or treatment or employment in,
its programs or accii i is appropriate auxiliary aids and services,when necessary to offer a person with a disability an
equal opportunity to pdr i i tt 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)250-4001.