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Home My WebLink AboutNCC241854_FRO Submitted_20240617 ` % BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/ ,. PLANNING & DEVELOPS- `.. _ t (828)t 250-4830-Planninglnfo@BuncombeCounty.org OWNERSHIP FORM FOR AN t www.buncombecounty.orglpfanning EROSION CONTROL PERMIT INSTRUCTIONS: All sections must be completed- Section E must be completed in the presence of a Notary Public. CASE NUMBER: E'cZ O) O;.L\ - b 0 b t A. Existing Property Information PIN(Numbers): ` ee / PIC P i Project Name: ffilig , i , r i tiw` e Latitude: Longitude: A `' t-+� Amount of fee enclosed: $ Project Location-Highway/Street:__dV k 6(1N 6.\;)r Y1 O h l a .5 1 , Proposed Use: \X Single Family Residence a Multi-Family ❑ Vacation Rental o ConimerciaUlndustrial/Othe,• a Other [Proposed Disturbed Area (Include offsite borrow and waste areas): c .S'' acre(s) B. Landowner(s) of Record* Name or Landowner(s)of Record: ikre�;, Z its �t �_� 1 �a � � l_l- MailingAddress: I?Va6 l!vn( PA U/bc. Ave , S dso Corrnetlos , Na asbas a Recorded in Deed Book No: 0QQ t!`� Page: V - 1 *Note: Attach accompanied page to list additional owners C. Contact Information—Financially Responsible Person** (Section 26-22S(b)of the Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Erosion control plans shall he 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 Applicant: Mailing Address: Street address: City f - State Zip E-mail address: Telephone: Cell: Fax: **Note:If the Financially Responsible Party is not the owner of the land to be disturbed,include with this form a copy(s)of the Soil Erosion and Sedimentation Control Agent or Landowner Authorization Form signed and dated with written consent for the applicant to submit an erosion control plan and to conduct the proposed land disturbing activities. D. Contact Information—Financially Res.onsible Company Company(ies)who are financially responsible for the land disturbing activity(Provide a comprehensive list of all responsible parties on 'accompanied page)If the company is a sole proprietorship or if the landowner(s) is an individual(s), the name(s)of the owner(s)may be listed as the financially responsible partv(ies)- Company Name: u\AAdt.50Y1 Simmons -}-bras c, Cprnm jh CS , L.-LC-- Mailing Address:_i na_5_ W ab 4t 1�n a CDrY� t 1 IA.S". NC 9 ElD3 Street Address_ 1�bc95 VJ QjitI„ t,�- ,/ k a Ave S As0 _Cana-ell u N�G a R-D31 City State Zip E-mail address: VOc e_--vn6 (� irYlotai Sws(m,(,l pash hY-Y1e5 eDM Telephone:1D L1 .C q 1- S Cell: Fax: E. Contact Information—North Carolina Agent (Registered) If the Financially Responsible Party is a domestic company registered on the North Carolina Secretary of State business rezistry,please provide information below of the Registered Agent: Name of Registered Name: al 1 s tb'71---)e r �\(-100r P ?"2 i Mailingg�r�, jam,., t ` ' C 1 Address:gyp �;��;1U. YIG- 4 t., S r)6o brneltt/(.i . NG aM31 Street Address 0 a.S IN etW b(i, Ave 4Sk Q Corn (, l RA,C N C (9 3.1A3 t E-mail address: " s t e,yl n G (' rvlUa 1.54,r) l yY)nil °CIS Y l o pil e, ` l vvyl City State Zip ITelephone: --.1oy.1:2191 .? 5e Cell: — - - Fax: i Rev Nov-23 F. Contact Information—North Carolina Agent(Non-Resident) Section 26-225(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 who is registered on the North Carolina Secretary of State business registry and is duly authorized by the financially responsible person to accept and convey correspondence regarding the aforementioned project. Name of Agent: Mailing Address: Street Address E-mail address: Telephone. Cell: Fax Signature: Date: G. Certification I.the undersigned, attest that I am the financially responsible party or an authorized representative with signatory authority for the financially responsible parry,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 Sod 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: C,l/,,, ^ , e `_ in UV�i 4 Cr Title: d�/t YYl !) Signature: Date: 1 1I ' a ba — 3 I. 6n n l L5 YI4 . a Notary Public for the County of re,d Q,l I State of►moo4(A CG voU t,j,. . hereby certify that Y'15 k-o \" V S\1ane 13�(� ��Nttt1111ln��,'' appeared before me this day and under oath acknowledged that the above form was executed by him and is correctJ� l twit, E 1,/ knowledge and belief. `�� T his s,�� ' Witness my hand and seal,this ` day of 4 "l�,lr 7 �Z c� V\A 20 aL\ s °TAR)e �Noe_d-,-764,9,AA _A_.../L.A__- My Commission Expires g I a q t a-oa 3 s pU BL, V` OFFICE Review Fee:S Permit\To.. '�� .�` USE Check No: .c'� �'i` r Date Paid Received by: Date Issued: S,s C co �4 �` The County of Buncombe does not discriminate on the basis of disability in the admission or access to, or treatment or employnre,zt in, t 11% its proaranis or activities. Requests for appropriate auxiliary aids and services, when necessary to offer a person with a disability an equal opportunio, to participate in or enjoy the benefits of County services, programs, or activities, may be made by contacting Buncombe County Erosion Control, (828)250-4848. Buncombe Countty's TDD number is(828)250-4001. FOR OFFICE USE ONLY Rnicw Fcc Pcmut No.: n.ltc FSSuzd: U.:c Pvd: Check Noy Rccd By: Rev Nov-23 Buncombe County Erosion Control Permit PINs and Addresses Lot # Street PIN Acreage 23a 171 Cherry Springs Ln 973147225700000 0.09 23b 173 Cherry Springs Ln 973147236000000 0.04 23c 175 Cherry Springs Ln 973147237200000 0.04 23d 177 Cherry Springs Ln 973147238400000 0.03 23e 179 Cherry Springs Ln 973147239700000 0.06 3a 154 Cherry Springs Ln 973147025100000 0.05 3b 156 Cherry Springs Ln 973147027300000 0.03 3c 158 Cherry Springs Ln 973147029400000 0.04 3d 160 Cherry Springs Ln 973147121700000 0.06 4a 146 Cherry Springs Ln 973137917300000 0.05 4b 148 Cherry Springs Ln 973137919500000 0.03 4c 150 Cherry Springs Ln 973147011600000 0.03 4d 152 Cherry Springs Ln 973147013800000 0.05 5a 138 Cherry Springs Ln 973137900500000 0.05 5b 140 Cherry Springs Ln 973137901700000 0.03 5c 142 Cherry Springs Ln 973137903900000 0.03 5d 144 Cherry Springs Ln 973137915100000 0.05 13a 139 Cherry Springs Ln 973136999600000 0.06 13b 141 Cherry Springs Ln 973146090700000 0.04 13c 143 Cherry Springs Ln 973146091900000 0.04 13d 145 Cherry Springs Ln 973147002000000 0.04 13e 147 Cherry Springs Ln 973147003200000 0.06 6a 130 Cherry Springs Ln 973136893600000 0.05 6b 132 Cherry Springs Ln 973136895800000 0.03 6c 134 Cherry Springs Ln 973137806000000 0.03 6d 136 Cherry Springs Ln 973137808200000 0.05 12a 129 Cherry Springs Ln 973136983700000 0.06 12b 131 Cherry Springs Ln 973136984900000 0.04 12c 133 Cherry Springs Ln 973136995000000 0.04 12d 135 Cherry Springs Ln 973136996200000 0.04 12e 137 Cherry Springs Ln 973136997400000 0.06 7a 122 Cherry Springs Ln 973136787800000 0.05 7b 124 Cherry Springs Ln 973136798000000 0.03 7c 126 Cheuy Springs Ln 973136890100000 0.03 7d 128 Cherry Springs Ln 973136891400000 0.05 11a 119 Cherry Springs Ln 973136876900000 0.07 lib 121 Cherry Springs Ln 973136888100000 0.04 11c 123 Cherry Springs Ln 973136889200000 0.04 lid 125 Cherry Springs Ln 973136980400000 0.04 11e 127 Cherry Springs Ln 973136981500000 0.06 8a 114 Cherry Springs Ln 973136771800000 0.07 8b 116 Cherry Springs Ln 973136782000000 0.04 8c 118 Cherry Springs Ln 973136783200000 0.04 8d 120 Cherry Springs Ln 973136785500000 0.05 l0a 109 Cherry Springs Ln 973136862800000 0.06 10b 111 Cherry Springs Ln 973136873000000 0.04 10c 113 Cherry Springs Ln 973136874200000 0.04 10d 115 Cherry Springs Ln 973136874400000 0.04 10e 117 Cherry Springs Ln 973136875600000 0.07 9a 106 Cherry Springs Ln 973136760500000 0.07 9b 108 Cherry Springs Ln 973136669800000 0.04 9c 110 Cherry Springs Ln 973136770100000 0.04 9d 112 Cherry Springs Ln 973136770400000 0.07 26a 211 Magnolia Springs Ln 973136825500000 0.07 26b 209 Magnolia Springs Ln 973136823800000 0.05 26c 207 Magnolia Springs Ln 973136832000000 0.05 26d 205 Magnolia Springs Ln 973136830200000 0.07 27a 212 Magnolia Springs Ln 973136930900000 0.05 27b 210 Magnolia Springs Ln 973136932600000 0.03 27c 208 Magnolia Springs Ln 973136933500000 0.03 27d 206 Magnolia Springs Ln 973136935200000 0.05 Total Acreage: 2.88