NCC220676_FRO Submitted_20220210

BUNCOMBE COUNTY
PLANNING & DEVELOPMENT
[phone] - Plannin91nWuncombeCounty org
www,buncombecounty org1planning
INSTRUCTIONS: All sections must be completed. Section E must be
completed in the presence of a Notary Public.
PIN (Numbers): 9731-44-1309
Latitude: 35.6598
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
Project Name:
CASE NUMBER:
Campfire Lodgings - RV Expansion Site
Amount of fee enclosed: S 1,050
Project Location - Highway/Street: 116 Appalachian Village Rd, Asheville NC 28804
Proposed Use: ❑ Single Family Residence ❑ Multi -Family ❑ Vacation Rental ❑ Commercial/Industrial/Other D4 Other
Longitude: -82.5918
Proposed Disturbed Area (Include offsite borrow and waste areas): 1.98
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 ofthe 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: N/A
Name of Applicant: Bill
Mailing Address: 506 Bellview Ave, Daytona Beach FL 32114
Street address: 506 Bellview Ave, Daytona Beach FL 32114
E-mail address: [e-mail]
Telephone: [phone] Cell:
Name of Landowner(s) of Record: Jack R Young Trust
Mailing Address: 506 Bellview Ave, Da ona Beach FL 32114
Recorded in Deed Book No: 1982 Page: 0471
Fax:
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: Matthew Fusco - Fusco Land Planning & Desi n PLLC
Mailing Address: P.O. Box 8013 Asheville NC 28814
E-mail address: [e-mail]
Telephone: [phone] 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: Bill Youn Title: Landowner
Signature: Date: IZ — / %
o, S. ne — $It d Notary Public for the County of O &46
State of rid h certify that tCrt I a Cif personally
appeared before me this day and under oath acknowledged that the above form was executed by him and is correct to the best of his
knowle lief.
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OFFICE Review Fee: $ Permit No.: Check No:
USE Date Paid: Received by: Date Issued: II
7lre County of Buncombe does not 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 with a disability an
equal opportunity to participate 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 [phone].