NCC221325_FRO Submitted_20220406

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DEVELOPMENT OWNERSHIP FORM FOR AN
(828) 2504830 - [e-mail] EROSION CONTROL PERMIT
www.buncom becounty.orglplan ping
INSTRUCTIONS: All sections must be completed. Section E must be CASE NUMBER:
completed in the presence of a Notary Public.
1\,. Lxisting Property information
PIN (Numbers): 9618-96-6464 9608-97-8911 Project Name: Mission Campus - {Phase 1 Revisions)
Latitude: 35.580316 Longitude-
-82.661523 Amount of fee enclosed: $ 4,200
Project Location - Elighwvay/Street: NCSR 1256, Propst Road
Proposed Use: ❑ Single Family Residence ❑ Multi -Family ❑ Vacation Rental 6(CommercialIIndustrial/Other ❑ Other
Proposed Disturbed Area (Include offsite borrow and waste areas):
4,200 acre(s)
C
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:
Airo Way, LLC Name of Applicant: Vladimir Grebenyk
Mailing Address: 2348 Smokey Park HWY Candler, NC 28715
Street address: 2348 Smokey Park HWY Candler, NC 28715
E-mail address: [e-mail]
Telephone:
Cell: 828-242-1879 Fax:
,� 4 .
Name of Landow-ner(s) of Record: Freedom In Christ, INC.
Mailing Address: 89 Pete Luther Rd Candler, NC 28715
Recorded in Deed Book No: 5668 Page: 1098
1101111111 In ..
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 nay knowledge and belief and was
provided by me while under oath.
Vladimir Grebe Title: Member, Airo Way, LLC
Name: )
Date:
Signature:
I, QZ . v �L�r>g� , a Notary Public for the County of
hereby certify that V �"`� L��r � �"w� u i�rrrrrrr11,o grsonally
State of _ t of his
appeared before me this day and under oath acknowledged that the above form was executed by him clti et�
knowledge and belief�01A
Witness my Band and seal, this day of _
Notary L 1 G '
My Commission Expires
OFFICE Review Fee: $ Permit No.:
Check No: „ � �""""`tag
USE Date Paid: Received by: Date issued:
The 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].