NCC242885_FRO Submitted_20240919

0BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DEVEi CPMENT OWNERSHIP FORM FOR AN
[phone]-Planninglnfio@BuncombeCourtty org EROSION CONTROL PERMIT
www.buncombecountyorglplanning
INSTRUCTIONS:All sections must be completed_Section E must be CASE NUMBER:
completed in the presence of a Notary Public.
A. Existing Propert; Information
PIN(Numbers): 8790-39-2943,8790-29-6595 Project Name: 231 Green Valley Road
Latitude: 35.643900924952575 Longitude: -82.72576368338453 Amount of fee enclosed:$ 7,350.00
Project Location-Highway/Street:231 Green Valley Road,Leicester,NC 28748
Proposed Use: x Single Family Residence ❑Multi-Family ❑Vacation Rental o Commercial/Industrial/Other o Other
Proposed Disturbed Area(Include offsite borrow and waste areas): 7 acre(s)
B. Contact Information—Financially Responsible Person
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 Business: Name of Applicant:Wesley Alderfer
Mailing Address: 10 Noahs Vly,Leicester,NC 28748
Street address: 10 Noahs Vly,Leicester,NC 28748
E-mail address: [e-mail]
Telephone:[phone] Cell: Fax:
C. Landowner(s)of Record
Name of Landowner(s)of Record: Wesley Alderfer and Carte Shope
Mailing Address: 10 Noahs Vly,Leicester,NC 28748
Recorded in Deed Book No: 5826 Page: 0080
D. Contact Information—North Carolina Agent at-Applicable)
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 and is duly authorized by the financially responsible person to accept
and convey correspondence regarding the aforementioned project.
Name of Agent:
Mailing Address:
E-mail address:
Telephone: Cell: Fax:
Signature: Date:
E. 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 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: Wesley Alderfer Title: 0� 7
Signature:
'�( �"t..q 041* Date: t/ 14
I, l wc,c tr 1�)LtJrr � / :r t'•.- ,a Notary Public for the County of r,r�CRr''��L
State of l`/O r TEA eel 6l t,14 .hereby certify that W'Si'y /)IIt tr rC l personally
oatk acknowledged that the above form waI executed by him and is correct to the best of his
Icepfltjs(DP41EW)Alis4HIRLIN I. OP
1 N tgeli a>I 7 1y day of T t �/ 20 Z .
Buncombe County
I My Commission Expires Apr 15, 2028 ( No_
My Commission Expires Ap.I IS7 2021
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