NCC222244_FRO Submitted_20220623

BUNCOMBE COUNTY
PLANNING & DEVELOPMENT
I.., — 4830 • [e-mail]
www.buncombecounty orglplanning
INSTRUCTIONS: All sections must be completed. Section E must be
completed in the presence of a Notary Public.
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
CASE NUMBER:
A. Existing Property Informatioti
PIN (Numbers): 9751-13.8252 Project Name: Asheville Development -Lot 3 & a Elk Mountain Scenic Highway
Latitude: 35,6588 Longitude:-82.5290 Amount of tee enclosed: S 540.75
Project Location - Highway/Street: Adjacent to 661 Elk Mountain Scenic Highway
Proposed Use: a Single Family Residence ❑ Multi -Fancily a Vacation Rental a Commercial/Induslrial/Other ❑ Other
Proposed Disturbed Area (Include offsite borrow and waste areas): 1.03 acre(s)
B.
Section 26-22M) 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 be/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 ofthe 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: AIBL Invest, LLC Name of Applicant: David Zimmerman
Mailing Address: 805 Kemp Road West, Greensboro, NC 27410
Street address:
E-mail address: [e-mail]
Telephone: Cel I: 336.202.3587 Fax:
C. Landowner(s) of Record
Name of Landowner(s) of Record: AIBL Invest, LLC
Mailing Address: 805 Kemp Road West, Greensboro, NC 27410
Recorded in Deed Book No: 4401 Page: 881
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:
E. Certification
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. 1 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: David Zimmerr9-AIBL Invest, LLC Title: Manager
Signature: Date: J-1-
I, h a Notary Public for the County of �T v i 1
State of N Cl- hereby certify that J/A%J+ IA ; N►M-r l IWEI % 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
knowledge and belief. r� %apt
Witness my hand and sea], this day of 26
Notary 1 #�b N
My Commission Expires •
OFFICE Review Fee: $ Permit No.: Check No: s
doo
USE
Date Paid: Received by: Date Issued: ' � •,':�
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TAFFY s
800 s
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The County of Buncombe does not discriminate on the basis of disability in the admission or access to, or treatment or empl •J
its programs or activities. Requests for appropriate auxiliary aids and services, when necessary to offer a person with a disalihi' tvj C©UN�
equal opportunity to participate in or enjoy the benefits of County services, programs, or activities, may be made by contac�l/rp0trr+4rtrrtW1011 `
Buncombe County Erosion Control, [phone]. Buncombe County's TDD number is [phone].