NCC220009_FRO Submitted_20220104

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
(829)2%4W0-Planninglnfo@Bunromi)ecounty.org OWNERSHIP FORM FoxA1v
www.buncomhecounty-orgfpianning EROSION CONTROL PERMIT
INSTRUCi'IONS: All sections must be completed. Section E must be CASE NUMBER:
completed in the presence ofa Notary Public.
PIN (Numbers): 9656-42-9536 Project Name: Busbee Phase I
Latitude: 35.5207 Longitude:-82,5200 Amount of fee enclosed: $ 13,125.00
Project Location - Highway/Street: Sweeten Creek Road US 25A
Proposed Use: ❑ Single Family Residence XA91rlti-Fonnly ❑ Vacation Rental ❑ Coutnuercial/indush•iol/Olher ❑ Other
Proposed Disturbed Area (Include offsite borrow and a nste n ens): 25.00 acres)
B. Contact Information — Fimincia)4, 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 ofa 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: Flournoy Development Group, LLCName of Applicant: Ryan Foster
Mailing Address: PO Box 6566 Columbus, GA 31917
Street address: 1100 Brookstone Centre Parkwa .Columbus, GA 31904
E-mail address: [e-mail]
Tetc'phonc- 706-243-9403 Cell:_ 706-566.0915 Fax:
C. Landowner(s) ofRecord
Name of an of Record: Biitmore Farms, LLC
Mailing Address: PO Box 5355 Asheville, NC 28813
Recorded in Deed Book No: 1222 l;sge: 0645
D.
Section 26-228(b) ofthe Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Ifthe 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 oC issued pursuant to this ordinance,
The petsunouted 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: t60. Mine Lake C.t, Ste 200 Ratei h, NC 276.15
E-mail address:
Telephone: Cell: ' Pnx.;
Signature: Date:
E. Ccrtification
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 i8 completed for the
above referenced project. I acknowledge receipt ofa copy ol'the County of Buncombe Soil Erosion and Sedimentation Control
Ordinance and have thereby been advised of the requirements therein:&%wel I As the penalties and resources available to the County in
the event of violation I• [Itr3 Ordinance: The above information is true and correct to the best of my knowledge and belief and was
provided by me wh under oath.
Name: Ryan F er TitleSVP, Development
: _
Signatu Date: +Q (�
i• uai� j;q (AC-1a Notary Public for the County U VACAC
State I). s hereby certify that 1L A^� ricrsonally
a}slxu tl b c this day i ittIll acknowledged that the above fon was executed by him and is correct to the best of his
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My CID toil INpires
Ol-7.7(j;J: �\\!�� Permit No : _ Check No:
itSts Date llfwl Received by: Dale Issued: _
The Count) of Buncombe does not discriminate on the basis of disability Ili the admission or access to, or bneatntent or employment in,
its programs or activities. Requresls for appropriate auxiliary aids and services, when necessary to offer a person with a disability an
equal opportunity to participate in or enjgy the benefits of County services, programs, or aclivilies, may be made by contacting
Buncombe County Erosion Control, [phone]. Buncombe Coun!V's TDD number is [phone],