NCC223495_FRO Submitted_20221011

BUNCOMBE COUNTY
PUNNING & DEVELOPMENT
[phone] - [e-mail]
www,buncombecounty.org/planning
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:
PropertyA. Existing i
PIN (Numbers): 9686-53-5576 R 9686-53-4772 Project Name: Fairview Mini Storage
Latitude: 35.525350 Longitude: -82.410010 Amount of fee enclosed: $ 2,136.75
Project Location - Highway/Street: 1366 Charlotte Highway Fairview, NC 28732
Proposed Use: ❑ Single Family Residence ❑ Midti-Family ❑ Vacation Rental ® ComnrercialIIndrrstrial/Other ❑ Other
Proposed Disturbed Area (Include offsite borrow and waste areas): 4.07 acres)
B. rResponsible
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: AREP Fairview, LLC Name of Applicant: Joshua Wilkes
Mailing Address: 2820 Selwyn Ave Suite 618 Charlotte NC 28209
Street address: 2820 Selwyn Ave, Suite 618 Charlotte, NC 28209
E-mail address: [e-mail]
Telephone: [phone] Cell: Fax:
C. Landowner(s) ofRecord
Name of Landowner(s) of Record: AREP Fairview, LLC Susan Miller
Mailing Address: 2820 Selwyn Ave Suite 618, Charlotte, NC 28209 12 Masters Way, Pooler, GA, 31322
Recorded in Deed Book No: 6248 Page: 1186 Deed Book No: 009E Page: 1145
D. pi i
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
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: Joshua Wilkes AREP Fairview, LLC Title: Member
Signature: 11M4, L`.444-v Date: i ao a a
I, 1 C a Notary Pu lic for the County ofA( a "Q -4
`_
State of hereby certify that QA "A V v I k,4.7 Jpersonally
appeared before day and under oath acknowledged that the above form was executed by him and is correct to the best of his
knowledge and belief.
Wit tess my handi���its "_+ day of�✓ _, 20
Notary Public Notary `
Mecklonburrt Co.,North Carolina p
My Cornmissi J, ,lone 1 NlyX024rn scion Expires 4 I, g 'ZUti
OFFICE . Review Fee: $ Permit No.: Check No:
USE Date Paid: Received by: Date Issued:
Ilie County of Buncombe does not discriminate on the basis of disability in the admission or access to, or treatment or eniplojnrrent in,
its programs or activities. Requests for appropriate auxiliary aids and services, when necessmy to offer a person with a disability an
equal opportunity to participate in or enjoy the benefits of Comity services, programs, or activities, Wray be made bj, contacting
Buncombe County Erosion Control, [phone]. Buncombe Comity's TDD number is [phone].