NCC242362_FRO Submitted_20240802

ceBUNCOMBE COUNTY FINANCIAL RESPONSIBILITY
P t..H r�,;r ; , E c ; < r OWNERSHIP FORM FOR A
(m 2504830 EROSION CONTROL PERMIT
rnrw.buncombecourdym9 /
INSTRUCTIONS:All sections must be completed Section E must be CASE NUMBER:
completed in the presence of a Notary Public,
PIN(Numbers): — — . — — Project Name: S y Ridge Su ivision
Latitude: 35.666247 Longitude: -82.591453 Amount of fee enclosed:$ 2,504.25
Project Location-Highway/Street. 3000 if west of intersection of SRi893 and SR1 9
Proposed Use: x Single Family Residence o Multi-Family o Vacation Rental ❑Commercial/Industrial/Other ❑Other
Proposed Disturbed Area(Include offsite borrow and waste areas): 4.77 acre(s)
R. I,aricloV-ucr(,i of ltccold*
Name of Landowner(s)of Record: Sky Ridge, LLC.
Mailing Address: 1854 Hendersonville Rd Ste A, Asheville NC 28803
Recorded in Deed Book No: 63 6 7 Page: 6 33
*Note:Attach accompanied page to list additional owners
C. Cnutect lnfnnnatinn—I ivanciallc Rc'puu.ihlc Pcr.on**
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 Applicant: Wesley Greene
Mailing Address: 1854 Hendersonville Rd Ste A, Asheville NC 28803
Street address: 1854 Hendersonville Rd Ste A
Asheville NC 28803
City State Zip
E-mail address: [e-mail]
Telephone: Cell: 828-337-2464 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 Iuform.uir,u—Financially Rc pon,iblc Ccunpanc
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 party(ies).
Company Name: Sky Ridge, LLC
Mailing Address: 1854 Hendersonville Rd Ste A, Asheville NC 28803
StreetAddress1854 Hendersonville Rd Ste A
Asheville NC 28803
City State Zip
E-mail address:[e-mail]
Telephone: Cell: 828-337-2464 Fax:
L. Contact Ltfnrni:uion—\orth(;;u ,lina,1;;cut(Rcui;tctccl)
If the Financially Responsible Party is a domestic company registered on the North Carolina Secretary of State business registry,please
provide information below of the Registered Agent:
Name of Registered Name:Wesley Greene (Managing Member)
Mailing Address: 1854 Hendersonville Rd Ste A, Asheville NC 28803
Street Address 1854 Hendersonville Rd Ste A
E-mail address: [e-mail]
Asheville NC 28803
City State Zip
Telephone: Cell: 828-337-2464 Fax:
Rev Nov-23

F. Contact Information-North Carolina_ cnt(won-Rc.Hunt)
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 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 fmancially 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 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: d�04J�P /ee4 Title: /1l�^�7/14ta407-4'
Si e: (� Date: �? ii
g�C�t jr �' �\ a Notary Public for the County o/f� •1 '���LLL```,�adt� � /VU,��ji
State of ►t/ hereby certify that ��E 5'e fir' (7 rp_4��� � •***s pu• uPv
appeared before me this day and under oath acknowledged that the above form as executed by him ands cilto ,besttdflP i
knowledge and belief. rf 0\ Z
Witness my hand and seal,this day of 1�'tj L�� 20 � ( .
Cf/)a _
No
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My Commission Expires )0_2 l -Ze Zy �iJJ�.•Go;. . ;:�
OFFICE Review Fee::$ Permit No.: Check No: ,'''
`,\
fi11 I I l l 11"
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 arailiary 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.
FOR OFFICE U.S.F.ONLY
Retiew Fee:
Pemrt No.:
Date Issued:
Date Paid
Check No.:
Reed By
Rev Nov-23