NCC243125_FRO Submitted_20241009

='= L UNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
L/ NNING & DEVELOPMENT OWNERSHIP FORM FOR AN
I [phone]-Planninglnfo@BuncombeCounty,org EROSION CONTROL PERMIT
• www.buncombecounty.orglplanning
INSTRUCTIONS:All sections must he completed.Section E must he CASE NUMBER:
completed in the presence of a Notary Public.
A. Existing Property Information
PIN (Numbers): 8687-22-2475, 8687-22-5495 Project Name: Tire Solutions Expansion
Latitude: 35°32'21.5"N Longitude: 82°45'28.9"wV Amount of fee enclosed:$ 2,021.25
Project Location-llighway/Street: 618&600 Old U.S. 19-23 Proposed Use: o Single Family Residence o Multi-Family
❑ l acation Rent,! $Commercial//ndustrial/Other ❑Other Proposed Disturbed Area(Include ojJaite burrow and WaSie
areas): 3.85 acrc(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.
(Managing Member;
Name of Business: Rice Holdings ASH, LLC Name of Applicant: Josh Rice Rice Holdings ASH,LLC)
Mailing Address: 7545 Morrow Mill Road Mebane,North Carolina 27302
Street address:
E-mail address: Jrice!a'tiresnc.com
Telephone: [phone] Cell: Fax:
C. Landowner(s)of Record
Name of Landowncr(s)of Record: Rice Holdings ASH,LLC
Mailing Address: 7545 Morrow Mill Road Mebane, North Carolina 27302
Recorded in Deed Book No: 6266 Page: 1058 _
1). Contact Information—North Carolina Agent (!£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. Certificatitin
1,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: Josh Rice(Managing Member; Rice Holdings ASH,LLC) Title: Managing Member
Signature: Date: 5)2
(4°5/(1`b ,a Notary Public for the County of
httt�vt�0,fi
n
State of �V 6.(441 l.d tiGt t f\ot ,hereby certify that l�e ic'")StY` Gk k4GQ personally .5 0 Z
OZ
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 rtm1
knowledge and belief. L 51 Z�
Witness my hand and seal,this day of gt2CT 20 9.3 y ' Q O
' O
Note c co _GO
Z
cis My Commission Expires (-el7 01.-. O7 V
OFFICE Review
Date Pa dee'5' Rennirho ;: Check No
iJSE ivied by. :, ,Date Issued. � V
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 after a person with a disability an
equal opportunity to participate in nr enjoy the benefits of County services,programs, or activities, mar he made by contacting
Buncombe County Erosion Control,[phone]. Buncombe County's TDD number is(828)250-4001.
Scanned with CamScanner