NCC231665_FRO Submitted_20230531

G4s0N coo JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
P '� Laud Disturbance: One-Half(1/2) or more Acres/Stormwater Installation
Financial Responsibility/Ownership Form
p •
2p _ Silva Office: 538 Scotts Creek Rd,Suite 205,Phone: [phone]/Fax: [phone]
'Qry CgO' Cashiers Office: 357 Frank Allen Road,Phone: [phone]/Fax: [phone]
No person may initiate a land-disturbing activity and/or stormwater installation before this form has been completed and
an acceptable erosion and sedimentation control/stormwater plan has been approved by the Jackson County Office of
Permitting&Code Enforcement. If work is started without an approved permit your permit fee will be doubled.
• Please type or print,and if any question is not applicable place N/A in the blank.
• Submit three(3)copies of the plan,a narrative, and the appropriate fee;please contact our office for
an accurate fee calculation before submitting paperwork. For fee calculation call 828-745-6850 or e-
mail [e-mail] or [e-mail].
• A surety bond is required for any disturbance of five (5) acres or more
Part A
1. Project Name: Cashiers Lake PIN see attached list
2. Location of land-disturbing activity/stormwater installation: (City or Township) Cashiers
Highway/Street Cashiers Lake Road Latitude 35.107 Longitude -83.103
3. This project will require the review of the following:n Erosion Control n Stormwater
Is this project within a regulated district?�No nYes—District: portion in Cashiers Commercial
4. Approximate date work will begin onsite:June 2023
5. Purpose of development (residential, commercial,industrial,etc.) residential
6. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 20.88 acres
7. Amount of fee$10,750 FOR OFFICE USE:Received? (initial/date)
8. Has an erosion&sedimentation control/stormwater plan been filed?nNo EYes EEnclosed
9. Person to contact should issues arise during land-disturbing activity/stormwater installation:
Name Troy Lucas E-mail Address [e-mail]
Phone Cell 704-906-9925 Fax
10. Landowners(s) of Record (Use blank page to list additional owners) Deek Bk/Pg (Provide a copy)
Name see attached list Phone Fax
Current Mailing Address
Part B
Company(ies) or firm(s)who are financially responsible for the land-disturbing activity(Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Cashiers Lake Investments,LLC [e-mail]
Name E-mail Address
3115 Timberlake Dr.Suite 100 same
Mailing Address Street Address
Vestavia AL 35243
City State Zip Code City State Zip Code
205-443-4730
Phone Number Fax Number
Note: If the Financially Responsible Party is not the owner of the land to be disturbed,include with this form the landowner's signed and dated
written consent for the applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing activity.

1. (a) If the Financially Responsible Party is not a resident of North Carolina,please give name and street
address of a North Carolina Agent.
Incorporating Service,Ltd
Name E-mail Address
176 Mine Lake Court,Suite 100
Mailing Address Street Address
Raleigh _ NC 27615
City State Zip Code City State Zip Code
Phone Fax Number
(b) If the Financial Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financial Responsible
Party is a Corporation,give name and street address of the Registered Agent.
Incorporating Service,Ltd
Name of Registered Agent E-mail Address
176 Mine Lake Court,Suite 100
Mailing Address Street Address
Raleigh NC 27615
City State Zip Code City State Zip Code
Phone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided by me under
oath. (This form must be signed by Financially Responsible Person if an individual or his attorney-in-
fact,or if not an individual,by an officer,director,partner,or registered agent with authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there
be any changes in the information provided herein.
Scott Jenkins Chief Financial Officer
Type or Pr' Name Title or Authority
ature Date
I, � i�i Notary Public of the County of jri6K2
fl
State of aieLbe f& hereby certify that Sect` ()en bnS _ appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by them.
Witness my hand and notarial seal,this /8 ay of nC ,20 ca
iiiihribri or dam iiibmift
CATHERINE CASANTA WILKES Notary
Notary,Pltblic
/ a Ga c�Alabama State at Large My Commission Expires b ` -

'��Sorl coG2T� JACKSON COUNTY OFFICE OF PERMITTING&CODE ENFORCEMENT
Land Development Application
y Q Sylva Office:401 Grindstaff Cove Rd,Suite 145,Phone: [phone]/Fax: [phone]
°9 cAP��\`, Cashiers Office: 357 Frank Allen Road,Phone: [phone]/Fax: [phone]
For Office Use: Fee Paid? ❑Yes (Paid) nNot Required Application number:
OWNER/APPLICANT INFORMATION
PIN: see attached list DATE: 4/6/23
Property Owner's Name(as listed on tax parcel): Local Contact's/Agent's Name:
See attached list Troy Lucas
Property Owner's Mailing Address: Local Contact's/Agent's Mailing Address:
F( 215 Cashiers Lake Road
Cit State Cit State �
U y I I Zi p Cashiers I NC I Zi p 0-3 28717 0
01
~. Property Owner's Phone Number: Local Contact's/Agent's Phone Number: by
a, 704-906-9925 41
Property Owner's E-MAIL Address: Local Contact's/Agent's E-MAIL Address: t•"
[e-mail] pa
lil
Contractor's Name(if known): Contractor's Phone(if known): d
►7 0
0
PROJECT/SITE DATA y
W Improvement Description:
Acreage of Disturbed Area: Building Size: I Power Provider: 4
W ❑1/2 or less acres ❑✓ E/C Plan has been filed. I
Methods to be used for Erosion Control: ()
Silt Fence Q✓ Berm/Diversions �✓ Temp. Gravel Construction Entrance
❑✓Seeding/Vegetation within 10 days of final grading 2 Other: skimmer basins
Utilities: QTWSA Well I=ISeptic El Other (Please spec' )
Specific Directions to Site:
Located south of Cashiers Lake on Cashiers Lake Road J Gate Code:
FOR OFFICE USE
Site's Physical Address: Parcel/Lot Size
Subdivision Name: Lot Number: Township: Municipality:
Fire District: High Quality Water: Stream Classification:
Is This Site Within:OWatershed OFloodplain OProtected Ridge E County Zoning District
SINGLE FAMILY RESIDENCE NEW EXISTING ADDITION/REMODEL NEW EXISTING
MULTI FAMILY DEVELOPMENT NEW EXISTING SUBDIVISION DEVELOPMENT NEW EXISTING
MANUFACTURED HOME NEW EXISTING OFF PREMISE SIGN NEW EXISTING
ACCESSORY STRUCTURE NEW EXISTING MOBILE HOME PARKS NEW EXISTING
RETAIL/OFFICE BUILDING NEW EXISTING COUNTY ZONING DISTRICT NEW EXISTING
INDUSTRIAL DEVELOPMENT NEW EXISTING
HEAVY COMMERCIAL NEW EXISTING MISC.GRADING
CERTIFICATION
I hereby certify that the information given above,to the best of my knowledge is true and correct. I am aware that the State and or
County staff can and will conduct periodic inspections of this project to ensure compliance.
I acknowledge that I have been informed of land use regulations subject to my property or development.
I understand that I must contact the Permitting Office at least one business day prior to any work commencing.
The signature below signifies full responsibility for all land disturbing activities on site.
Owner's/ ent's Si e: Date:
‘e,11/2 3
Approved to proceed with permitting process when signed by Permit Center staff. Date
You may submit a completed,signed copy of this application to our office in person,by fax, or e-mail to
[e-mail]. Fees may be required.

sON co JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
Request for Surety Bond to Disturb Land
*Only Required for Five or More Acres of Land Disturbance*
2 �' •
Q
O _ �? Sj'lva Office:401 Grindstaff Cove Rd,Suite 145,Phone: [phone]/Fax: [phone]
RTN cgPO" Cashiers Office: 357 Frank Allen Road,Phone: [phone]/Fax: [phone]
Per the requirements of the Jackson County Code of Ordinances (Chapter 10,Environment,Article VI,
Jackson County Sediment Control Ordinance,Division 5,Section 10-310),Jackson County hereby asks
for the issuance if a surety bond to be held by the County for the following project:
Project Name: Cashiers Lake
Property Identification Number: see attached list
Land Owner(s)of Record: see attached list
Financially Responsible Person: Cashiers Lake Investments, LLC
Project or Site Location:
The reason for this bond request is as follows: As per Section 5.3.11 (3) of the ordinance,"Forfeited
surety shall be used to establish erosion control structures or ground cover in accordance with an approved
sediment control plan."
Conditions of default for the right of redemption: As per Section 5.3.11 (1)of the ordinance,"Land-
disturbing activities not in compliance with this ordinance or an approved sediment control plan for 90
working days after notice of violation is received through registered mail or certified mail or other means
detailing specific items of violation,shall be subject to forfeiture of all applicable surety."
Please be advised that,as per the ordinance,"Such surety shall be valid until the land-disturbing
activity is completed in accordance with the approved sediment control plan and released by the
Administrator..."As a matter of standard operating procedure in Jackson County's Erosion Control
Program,it has been determined by the Commissioners that the land-disturbing permit for any site required
to have a surety bond will only be in effect for the same amount of time that the bond is in force. If the
bond lapses before the County closes out the site,the land-disturbing permit will be revoked immediately.
If the bond applicant(which will likely be the person financially responsible for the project or the land owner
of record) allows the bond to prematurely expire (before the permitted area is closed out by the County),
applicable violations on the area being disturbed will be cited and a new application for a permit to disturb
land will be called for by the County. Please be advised this means civil penalties may be assessed,and all
application fees will again have to be paid at current applicable rates.
An application to disturb 20.88 acres acres of land in Jackson County has been
submitted by Cashiers Lake Investments,LLC . At the rate of$ 2,000.00
per acre disturbed, the total surety bond amount requested will now be stated as
$ 42,000.00 . The original bond will be held by"Jackson County", and should be sent to
the above stated address.
By: 4 Ict %(.- SteOc.)l3 ..lnSvia,sc co. for Jackson County on `'f-/o- Zo2

G,$ON Coo JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
-3 �.4 Land Disturbance: One-Half(1/2) or more Acres/Stormwater Installation
� nr`; •
Owner Affidavit for Financially Responsible Parties
,,
O _ � Sylva Office:538 Scotts Creek Rd,Suite 205,Phone: [phone]/Fax: [phone]
rii COP�O' Cashiers Office: 357 Frank Allen Road,Phone: [phone]/Fax: [phone]
If the Financially Responsible Party listed on the application to disturb land is not the owner of the property, this
form must be completed by the property owner and submitted with the application.
Parcel Identification Number and location where land disturbance permitting is requested:
PIN 7571-38-9262 located at 215 Cashiers Lake Road
Arrowood Station,LLC
Full Printed Name Phone Number
I certify that I am the property owner of record for property mentioned above.
OR
I certify that I am legally authorized to act on behalf of the firm or corporation that owns this
property; owned by: Arrowood Station,LLC
Printed Name of Firm or Corporation
I am appearing personally before the undersigned notary and,being duly sworn, stating that I have
given my consent for a financially responsible party to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity on my property. My authorized
financially responsible party will be:
Scott Jenkins Cashiers Lake Investments,LLC
Financially Responsible Party's Printed Name Firm Name(f applicable)
Arrowood Station,LLC
By:NC Real Estate Ventures,LLC,its manager
By:NC REV Manage eat,LLC,its manager
By: � ,.,,_ A — 17 -).Z
Signature of Property Owner Turner Inscoe,Manager Date
I, Susan Shalhoop ,a Notary Public of the County of Shelby
State of Alabama ,hereby certify that Turner Inscoe appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by them.
Witness my hand and notarial seal,this Ik' I '" "day of April ,20 23 .
\.'I 1, 1lR .A .III w V♦A 4�r
•'','`u'� :,,- MAN SHAI.HOOP
_* N0«"•"Y CI My CameExpires Signature of Notary
,,• October 22,2024
My Commission Expires tq2212C)21—

161;i:
4.5ON Coo JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
Land Disturbance: One-Half(1/2) or more Acres/Stormwater Installation
Owner Affidavit for Financially Responsible Parties
, Sylva Office:538 Scotts Creek Rd,Suite 205,Phone: [phone]/Fax: [phone]
Rrh cARO\' Cashiers Office: 357 Frank Allen Road,Phone: [phone]/Fax: [phone]
If the Financially Responsible Party listed on the application to disturb land is not the owner of the property, this
form must be completed by the property owner and submitted with the application.
Parcel Identification Number and location where land disturbance permitting is requested:
PIN 7571-38-0837 located at 58 Ling-r Lane
Cashiers Canoe Club Development,LLC
Full Printed Name Phone Number
I certify that I am the property owner of record for property mentioned above.
OR
I certify that I am legally authorized to act on behalf of the firm or corporation that owns this
property; owned by: Cashiers Canoe Club Development,LLC
Printed Name of Firm or Corporation
I am appearing personally before the undersigned notary and,being duly sworn, stating that I have
given my consent for a financially responsible party to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity on my property. My authorized
financially responsible party will be:
Scott Jenkins Cashiers Lake Investments,LLC
Financially Responsible Parry's Printed Name Firm Name(f applicable)
Cashiers Canoe Club Development,LLC
By:NC Real Estate Ventures,LLC,its manager
By:NC REV Managei t,LLC,its manager
By: ./449 --13—
Signature of Property Owner Turner Inscoe,Manager Date
I, Susan Shalhoop ,a Notary Public of the County of Shelby
State of Alabama ,hereby certify that Turner Inscoe appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by them.
Witness my hand and notarial seal,this ,711ay of April ,20 23 .
♦ r \ ♦.
°"'€p':, SUSAN SHAUIOOP Signature of Notary
NOTARY
'4 ' My Commission Expires tC 4''/ ��