NCC232558_FRO Submitted_20230828

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DEVELOPMENT
1 OWNERSHIP FORM FOR A
(828)[e-mail]
www.buncombecounty.org/planning STORMWATER PERMIT
INSTRUCTIONS: All sections must be completed. Section D must be CASE NUMBER:
completed in the presence of a Notary Public.
A. Existing Property Information
Project Name: Cole Road Subdivision
PIN(Numbers): 9700-83-8188
Latitude: 35.6266 Longitude: -82.6722 Amount of fee enclosed: $1,207.5
Project Location-Highway/Street:Cole Road
Proposed Use: I Single Family Residence ❑Multi-Family ❑ Vacation Rental ❑ Commercial/Industrial o Other
Proposed Disturbed Area(Include offsite borrow and waste areas): 2.3 acre(s)
R. Applicant Contact. Information
Name of Applicant: JOSEPH THOMAS ELLER State of Business Registration (if applicable):
Applicant's Point of Contact(for official correspondence):
Mailing Address: PO Box 18491, Asheville, NC, 28814
Street address:
E-mail address: [e-mail]
Telephone: Cell:828-545-5555 Fax:
C. Landowner(s) of Record
Name of Landowner(s)of Record: ELLER JOSEPH THOMAS, ELLER JEFFREY SCOTT
Mailing Address: PO Box 18491, Asheville, NC, 28814
Recorded in Deed Book No: 5716 page: 1584
Name of Landowner(s)of Record:
Mailing Address:
Recorded in Deed Book No: _ Page:
Note:If applicant is not landowner of record,provide executed Buncombe County Stormwater Agent Authorization Form
D. 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 installation,operation,and maintenance of the stormwater controls until ownership
is conveyed for the above referenced project. I acknowledge receipt of a copy of the County of Buncombe Stormwater Management
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.
Financially Responsible Party: JOSEPH THOMAS ELLER
Signature: Date: S'(d-13
Name: SoS o r o.) Cl lee- Title: O Li ese r
I, ,S k reu.N 0 L J.1 t)'F ,a Notary Public for the County of I- Cr)U., -/
State of N 0 r (r.•-ol•} . ,hereby certify that .)o S f pf C I I P. - 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.
Witness my hand and seal,this 1 0 day of p.k.tS„s l ,20 2�
SHAWN D. WILDES Notary rckctt�.--, t-' t J I c s
NOTARY PUBLIC
Henderson County My Commission Expires
North Carolina
1 MV Commission Expires 2 icfr24
OFFICE Review Fee:$ Permit No.: Check No:
USE Date Paid: Received by: Date Issued:
The County of Buncombe does not discriminate on the basis of disability in the admission or access to, or treatment or employment in,
its programs or activities. Requests for appropriate auxiliary aids and services, when necessary to offer a person with a disability an
equal opportunity to participate in or enjoy the benefits of County services, programs, or activities, may be made by contacting
Buncombe County Erosion Control, [phone]. Buncombe County's TDD number is(828)250-4001.