NCC216194_FRO Submitted_20211108

BUNCOMBE COUNTY
PLANNING 8=VELOPMENT
[phone] - [e-mail]
www.buncombecounty.orglplanning
INSTRUCTIONS: All sections must be completed. Section E must be
completed in the presence of a Notary Public.
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
CASE NUMBER:
A. Exis(ing, Propert% Information
PIN (Numbers): See atached Project Name: Hamrirk Farms
Latitude: Longitude: Amount of fee enclosed: $
Project Location - Highway/Street: Lower Edgewood Road
Proposed Use: a Single Family Residence ❑ Multi -Family ❑ Vacation Rental o Commercial/IndustriaUOther ❑ Other
Proposed Disturbed Area (Include offsite borrow and waste areas): 1.83 acre(s)
B. Contact Infofniation Fiiianci�illvi�,�1,4pii�ii�lt,Persi)fI
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: D.R. Horton Inc Name of Applicant: Ian Miller
Mailing Address: 2 Walden Ridge Dr., Ste 80. Asheville, NC 28803
Street address: Same as above
E-mail address: [e-mail]
Telephone: [phone] Cell: Fax: _
C. Landowner(s) of Record
Name of Landowner(s) of Record: D. R. Horton Inc _
Mailing Address: 2 Walden Ridge Dr., Ste 80. Asheville, NC 28803
Recorded in Deed Book No: 6127 Page: 1043-1046
D. Contact Inforination North Carolina Ag�eiit (II'Applit'..1171c)
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:
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: Ian Miller Title: DSCR
Signature: Date: 10-20-2021 t _
1,_6aic r,C 'a_ . a Notary Public for the County of M_am)oiz.
State of t I I I I I I I! a
,, hereby certify that Aft 1 1 1 �kQ_y personally
appeared b 0� i ���(]7!is (14e hider oath acknowledged that the above form was executed by him and is correct to the best of his
knowledOY11elief.
Witnes&�'infl�and and seal, this,zs"? day of 20
Notary Public
Buncombe = Not
County Z My Commission Expires a'
OFFICE ��' S iew Fee: $ Permit No.: Check No:
USE ��j� V ���� Received by: Date Issued:
The County ofBuoV6W6k1A1 R'inot 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 will¢ a disability an
equal opportunity to participate in or eryoy the benefits of County services, programs, or activities, may be made by contacting
Buncombe County Erosion Control, [phone]. Buncombe County's TDD number is [phone].

Lot 29: 961727626000000
Lot 30: 961727620000000
Lot 31: 961727514900000
Lot 32: 961727419900000
Lot 39: 961727105900000
Lot 40: 961727008900000
Lot 64: 961727507200000
Lot 65: 961726592800000
Lot 66: 961726498400000
Lot 67: 961726493200000
Lot 68: 961726397300000
Lot 69: 961726391400000
Lot 11: 961736192900000