NCC224190_FRO Submitted_20221228

BUNCOMBE COUNTY
I._ANNING & DEVELOPMENT
_ [phone] - [e-mail]
www• bu n combecou nty. orglp iann in g
INSTRUCTIONS: All sections must be completed. Section F. must be
completed in the presence of a Notary Public.
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
CASE NUMBER:
PIN (Numbers): 9730-88-0404 & 9730-88-5712 . Project Name: The Terraces at Reynolds Mountain West
Latitude: 35°38'32.4758 Longitude: 82°34'24.6070 Amount of fee encloNW: S 3,937.50
Project Location - HigbwaylStreet: 99999 Senator Rey_nolds.Road
Proposed Use: 14ingle Family Residence ❑ Multi Family ❑ Vacation Rental ❑ ComsnerciallIndminal/Uther ❑ Drher
Proposed Disturbed Area (Include r ffvire borrow and waste areas): 7.4 acre(s)
Section 26-228(b) of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Erosion control pla nis 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
wel I 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 e:nvcred by the application-
Nameof l3usiness: Sk fin Developers LLC Name of Applicant:_ Harold Kessler
Mailing Address: P.O. Box 1743, Enka, NC 28728
Street address:
F.-mail address:
Telephone: [phone] Cell: Fax:
Name of Landowners) of Record: _Young Mens Christian Association of WNC Inc
Mailing Address: _ 40 N Merrimon Ave Ste 309, Asheville, NC 28804
Recorded in Deed Book No: 5545 Page: 1962
Section 26-228(b) ot'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:__ Ccll: T Fax:
Signature: Date: i
I, the undcrsigrKxl, aft" 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 ofthe site until ownership is completed for the
above referenced project. 1 acknowledge receipt of copy of the County of Buncombe Soil Erosion and Sedimentation Control
Ordinance and have thereby been advised of the requirements therein as wel I as the penalties and resources available to the County in
the event of violation of the Ordinance:. Thr above information is true: and correct to the best of my knowledge and belief and was
provided by me while under oath.
Name: v, ca! A k e s' Y _ Title: t+i 1'1 p q Q rr
Signature: src�tr - Date a Z v aZ
1, a Notary Public I'Ur the County of
State of hereby certify that - R personally
appeared before me this day and under oath acknowledged that the above form was executed by him and is correct to the beast of his
knowledge and belief.
Witness my hand and seal, this day of 20
Notary
wrrrrss
My Commission Expires
OFFICE Review Fee: S Permn No.: Chock No:
USE Date Paid: — - - Received by: Date Issued_
The Cathy of Buncombe dnes not diverimirurte nn thr huvi.c rd e ivwhilitu in tho ndmiccinn nr n eovv ►n nr — a.,..,r.., ,.. a..► i.,
its programer or activities. Requests far appropriate auadliaty aids and services, when neeeswry to offer a person with a disability an
equal opportunity to participate in or enjoy the henefus of County services, programs, or activities, may he matte by contacting
Buncombe Count• Erosion Control, [phone]. !turn omhe Counry's TDD number is [phone].

Acknowledgment by Individual
State of Florida
County of
The foregoing instrument was acknowledged before me this
of March 20 22
Harold Kessler
day
by means of ® physical presence or j-, online notarization
(name of person acknowledging),
❑ Personally known to me
® Produced Identification
Type of Identification Produced - D! iYer's license
Notary signature ge�J
Notary name (typed or printed) Adrian Nodal
Title (e_g., Notary Public) Notary Pub
Place Seal Here
State of Florlde
W.0*41
&4YC&wnMfon Expires 01131MM
Commission No. HH 87363
For Bank Purposes Only Description
of Attached Document
Type or Title of Document
(-1'7j/Y+ V'a; k-e-won a6, lee* �'Cr a,,,, ��D'nvr7rl (-?cW, br,
Document Date Number of Pages
03110/2022
Signer(s) Other Than Named Above
Account Number (if applicable)
�n 2020 Wells Fargo Bank, N.R. All rights reserved.
OSG5350FUS95501 (Rev 05- 05121)
1