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HomeMy WebLinkAboutNCC242776_FRO Submitted_20240909 BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/ PLANNING & DI "rLOPMENT OWNERSHIP FORM FORA (828)250.4830•Planninglnfo@BuncombeCounty.org STORMWATER PERMIT www,buncombecounty.orglplanning INSTRUCTIONS:All sections must be completed.Section D must be CASE NUMBER: completed in the presence of a Notary Public. k. Existing,Property Information Project Name: Atlas Precision Expansion PIN(Numbers): 963551388200000 Latitude: -82d,34',41.21" Longitude: 35d,29',16.47" Amount of fee enclosed:$ Project Location-Highway/Street:170 Clayton Road,Arden,NC 28704 Proposed Use: o Single Family Residence o Multi-Family o Vacation Rental I Commercial/Industrial o Other Proposed Disturbed Area(Include offsite borrow and waste areas): 1.0 acre(s) B. Applicant Contact Information Name of Applicant: Hofschuster,Johann State of Business Registration(if applicable): NC Applicant's Point of Contact(/br official correspondence): Mr.Johann Hofschuster Mailing Address: 170 Clayton Road,Arden,NC 28704 Street address: 170 Clayton Road,Arden,NC 28704 E-mail address: jhofschu@gmail.com Telephone:828-687-9900 Cell: Fax: C. Landowner(s)of Record Name of Landowner(s)of Record: Hofschuster,Johann Mailing Address: 170 Clayton Road,Arden,NC 28704 Recorded in Deed Book No: 1820 Page: 0631 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. Financia y. knsible Party. Mr.Johann Hofs st Signature,4,82` I Date: (�iva L( Nam x$,[,1rx to r. Title(1) Q.S ' µ 1:.�►h n I,0 k fK(vl a Notary Public for the County of _ �. State of�(Jr 0�4 hereby certify that c ' � SjC3AUS Q personally appeared before me this day and under oath acknowledged that the above form was executed by him and is correct to the best of his knowledge and belief. 11llll at-r Witness my hand and seal,this ' 1 \.ss :fS ktary ( �pTARy , k4- I301a9 ' r Mjommission Expires r r OFFICE Review Fee:$ �l°NhI)rtNo. 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,(828)250-4848. Buncombe County's TDD number is(828)250-4001.