NCC222005_FRO Submitted_20220601

�7 Nota
Bur
MY C
y 05•
BUNCOMBE COUNTY
PLANNING & DEVELOPMENT
(a, --483o - [e-mail]
www.buncombecounty.orglplanning
INSTRUCTIONS: All sections must be completed. Section E must be
completed in the presence ofa Notary Public.
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR. AN
EROSION CONTROL PERMIT
CASE NUMBER:
A. Existing Property hil'orination
PIN (Numbers). 9657-75-2415, 9657-65-e108, 9667-75-3093 Project Name: Blit—re Terrace subdivision - Phase 4
Latitude: 35.554186 Longitude: '82.5Q6324 Amount of fee enclosed: S 1,443,75
Project Location - Highway/Street, Loblolly Lane 1 Oakley Dogwood Drive
Proposed Use: ❑ Slagle FmnllvResidence 0 multi -Family ❑ Vacation Rental ❑ Comnzerciai/Indnstrial/Other ❑ Other
Proposed Disturbed Area (hrchrde of%;rite harrow and waste areas): 2.75 acre(s)
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 I be signed by the person
financially responsible for the land disturbing activity or his attomey in fact. The undersigned states that lie/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: Biltmore Terrace Development, LLC Name of Applicant: David Ross
Mailing Address: 1472 Patton Ave, Suite A, Asheville, NC 28806
Streetaddress: 1472 Patton Ave, Suite A, Asheville, NC 28806
E-mail address: [e-mail]
Telephone: [phone] Cell: Fax:
C. Landownef(s) of Record
Name of Landowner(s) of Record: Biltmare Terrace Development, LLC
Mailing Address: 1472 Patton Ave, Suite A, Asheville, NC 28806
Recorded in Deed Book No: 6D67, 5553 page, 0226, 0399
D. Contoct Information — North Carolina Agent (IfAppYcable)
Section 26-228(b) of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "If the person financially responsib:e
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 Nortli 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:
E. Certification
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 ofa 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 time and correct to the best of my knowledge and belief and was
provided while u"I ��.J 4ti
lkilhl6^./ uC ds Title: 6M Y
r I Z `1 Z
Stgn�a�: rrr � Date:
r - a Notary Public for the County of
Mbo� �� here y certify that tLy t +� I� U 5 personally
Dh�$tk d before uie this day and under oath acknowledged that the above form was executed by him and is correct to the best of his
6iht3L,rl�trnd bzlief.
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silfi�i Ss61n)A0 and seal, this day of 20'2�.
G ARO�t\ Notary
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MyCommissionExpires— Cam— I 0a(-a
OFFICE Review Fee: $ Perrnit No.: Check No:
USE Date Paid: Received by: Date lssucd:
The Cowzty of'Banconzhe does not discriminate on the hasis of'disahifi0- in the admission at- access to or treatment or euzplownent III,
its programs or activities. Requests for appropriate atr_ciliary aids and services, when necessary to offer a person with a disabililp an
equal opportunity to participate in or enjoy the benefits of Cotatty services, programs, or activities, maybe made by contacting
Buncombe Counh, Erosion Control, [phone]. Buncombe CnanV s TDD nuniher° is [phone].