NCC242776_FRO Submitted_20240909

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DI "rLOPMENT OWNERSHIP FORM FORA
[phone]•[e-mail] 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: [e-mail]
Telephone:[phone] 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$,[,1rx to r. Title(1) Q.S ' µ 1:.�►h
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I,0 k fK(vl a Notary Public for the County of _ �.
State of�(Jr 0�4 hereby certify that c ' � SjC3AUS Q personally
appeared before me this day and under oath acknowledged that the above form was executed by him and is correct to the best of his
knowledge and belief. 11llll
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Witness my hand and seal,this ' 1 \.ss :fS
ktary (
�pTARy , k4- I301a9
' r Mjommission Expires
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OFFICE Review Fee:$ �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,[phone]. Buncombe County's TDD number is(828)250-4001.