NCC220435_FRO Submitted_20220124

BUNCOMBE COUNTY
t828) 250.4830 • [e-mail]
www.buncombecounty.orglplanning
INSTRUC'rIONS: All sections must be completed. Section E most be
completed in the presence of a Notary Public.
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
CASEN(1MBER:
A. Existinp Property Information
PIN (Numbers): 9626-534920.00000 Project Name: MWKMe"lliage
Latitude: 35.0344 Longitude: -83.8204 Amount of fee enclosed: $ 5,250.00
Project Location -Highway/Street: 79 Morris Road, Asheville, NC 28806
Proposed Use: ❑ Single Family Residence txMidli-Family ❑ Yucaiion Rental ❑ Commercial/Industrial/Oilier ❑ Other
Proposed Disturbed Area (Include offshe borrow and waste areasit 10.0 _acre(s)
B. ConLict Informiation - Financially Responsible Person
Sectioq 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 responsibitily and ownership". This statement shalt 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: Broad River Village Group Name of Applicant: Mr. Scott Gillispie
Mailing Address: 10474 Broadview Road, Broadview Heights, OH 44147
Street address: SAME
E-mail address: Scott@ deepriversouth.com T -
Telephone: [phone] _ Cr11:[phone] _ Fax: _...
Name of Landowner(s) of Record: WM Lance and Jeanne Lance^ -
Mailing Address: 113 Fulbourn PI„ Myrtle Beach, SC 29579
Recorded in Deed Book No: _ 1531 Page: 0608.___
Section 26.228(b) of the Buncombe Countv 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 or issued pursuant to this ordinance."
The person noted below is the designated North Caro€ina agent and is duly authorized by the financially responsible person to accept
and convey correspondence regarding the aforementioned project.
Name of Agent: Reece M. Schuler
._._._. - -- _ .-
Mailing Address: 1318 Patton Ave Ste F, Asheville, NC 26806
E-mail address: RMSchuleraVaughnmelton.com
Telephone: [phone] Cell: [phone] Fax:
Signature: Date:
1, 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 ofthe 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: �{�_ _.. ' ^' J Title: m4w&, —
Signature: Date: % cif
I, i ��+- J mac, a Notary Public for he County of � _� e et,- � L
t! -i"�` 1 6�r*t�l G personal) ♦N�\
State of ute Goa •n G ,hereby terlify that [ o ._ y
appeared before me this day and under oath acknowledged that the above form was executed�m and is correct to the best of,
knowledge and belief. !' .: S
eo
Witness my hand and seal, this tA, day of 4e-_ 20 v
Notary
'Zb y ��i�0•
My Commission Expires l 7
OFFiCE Review Fee: E � Permit Nu.:_ -... Check No: ------- _ �
USF iYate Paid: Received by: bale Issued:
The County of Buncombe does not discriminate on the hasis of disahilily in the admission or access to, or treatment or ernplr{vmenl fn,
its programs• or activities. Requests for appropriate auaviliary aids and sen•ices, when necessary to offer a person with a dlsabilify an
equal opportunity to participate in or enjoy the benefas• of County services, programs, or activities, may be made by conlactorg
Buncombe County Erosion Control, (828) 2504848, Bunconrhe Couniy's TDD number 4 [phone],