NCG551558_Owner (Name Change)_20210712

ROSY COOPER
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)OHN NICHOLSON , 1 11 1�j 46"
Inman S.,...1' �," ''' 3UL
S.DANIEL SMITH NORTH CAROUNA
Mee.- EnMmaeYd QY J'
NcpEQ10\1\I DEs
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: N('00 / / / / or NCG55/1/E/r./.
1. Facility Name: 4 6 VAy A\G 1\\ " `��1e w�
L.I3k
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of: ,
a. Change in ownership of property/company
b. Name change only
c. Other(please explain):
2.New owner's name(name to be put on U
ermit): '^ Ian
(Za•rv1 to PJorr\e.* ? 1)elora c�►.+�
3. New owner's or signing official's name and title:
or
ROA%V\ fir\ '
(Person legally responsible for permit)
Ar o ,D s; 4r ra :z n t E ,I (I itic) QI I
ti ,0l. zsa!! !rs)i.r t t ;zz„k 9!!r.n.,s. �.....,. ,?awl:4r,.' V1,<
4. Mailing address: City:
9 V\ 0 cicL S r blsd . 0crrva,ria Pita c h
t. 3a 11le
State: /ip Code: Phone:
(tie) 3u. agci - 3 9 ( :riN ) 3%-c, - 39 I - 41 1
E-mail address:60 o `c.., Y`J"`Yo . C cvv
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF
THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.

REQUIRED ITEMS:
1.This completed application form
2.Legal documentation of the transfer of ownership(such as a property deed,articles of incorporation,
or sales agreement)
[see reverse side of this page for signature requirements]
Applicant's Certification:
•
I, RRtIN&An& -WalkI a Y attest that this application for a
name/ownership change has been reviewed and is accurate and conrlrlete'to the bgst of my knowledge. I
understand that if all required parts of this application are not completed and that if all required
supporting information and attachments are not included,this application package will be returned as
compl e.
'1► SV20z1
Signature:
THE COM ETED APPLICATION PACKAGE,INCLUDING ALL SUPPORTING
INFORMATION&MATERIALS,SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ/DWR/NPDES
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Version 11/2020

BK:00462 PG:0963 FILED
SWAIN COUNTY NC
trVAIN COUNTY TAX OFFICE DIANA WILLIAMSON KIRKLAND
REGISTER OF DEEDS
Date f j`�"18 `FILED Nov 02, 2018
Stamps 47 1c�(1Q.0� AT 10:51:38 am
PIN (ogpq-ao-Svc- to Q79 BOOK 00462
Signatur ! START PAGE 0963
(ALL TAXES P OW THIS PARCEL ONLY) END PAGE 0965
INSTRUMENT# 01860
EXCISE TAX $1,200,00
Drafted by:
PAVEY LAW FIRM,P.A.
Attorney&Counselor at Law
33 Dillsboro Road
Sylva,North Carolina 28779
Brief Description for index:
Mystic Village,Lot V6
PIN#6509-00.82-6979.0.38+1-acres
Nantahala Township,Swain County,NC
Revenue$1,200.00
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this the I day of November,2018,by and between,
ARTHUR S.LAZARUS,unmarried,of P.O.Box 25395,Greenville,South Carolina
29616(hereinafter referred to as"Grantor");and RAMIN DARIUS BONNET and wife,
DEBRA JEAN VAN ORDEN,of 727 Ocean Shore Blvd.,Ormond Beach,Florida
32176(hereinafter referred to as"Grantees").
WITNESSETH •
The Grantor,for good and valuable consideration paid by the Grantees,the receipt
of which is hereby acknowledged,has,and by these presents does grant,bargain,sell and
convey unto the Grantees in fee simple,all of that certain lot or parcel of land situated in
Nantahala Township,Swain County,North Carolina,and more particularly described as
follows:
BEING AND COMPREHENDING a tract of land containing 0.38 of an acre,
more or less,and being all of Lot V6,more particularly described on attached
Exhibit"A",which is fully incorporated herein.
AND BEING the same lands conveyed unto the Grantor herein by deed recorded
in Book 404,Page 182.Swain County Public Registry,to which reference is
hereby made and incorporated herein as if fully set forth.
This conveyance is made subject to the lien for ad valorem taxes for the current
year and all easements,restrictions and conditions of record and affecting said
property,
All or a portion of the property herein conveyed does not include the primary
residence of the Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges
at?Anctenances thereto belonging to the Grantees in fee simple.
And theatltor covenants with the Grantees,that Grantor is seized of the premises
in fee simple,has the right to convey the same in fee simple.that title is marketable and free