NCC243608_FRO Submitted_20241121

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
(828)[e-mail] OWNERSHIP FORM FOR AN
www.buncombecoumy orgiplanning EROSION CONTROL PERMIT
INSTRUCTIONS:All sections must be completed.Section E must be CASE NUMBER:
completed in the presence of a Notary Public.
PIN(Numbersl: 0607a1_1wea Project Nome; AL STERN ow FORT ROAD
Latitude: 35.55070459620058 Longitude: -82.33541587957521 Amount of fee enclosed:S 1890
Project Location-Highway/street:99999 OLD FORT ROAD
Proposed Use: a Single Family Residence c Multi-Family Vacation Rental Commercial'IndustriarOther L Other
Proposed Disturbed Area(Include offsite borrow and waste areas): 1.8 acre(s)
I ( �i•,rm.:ai - I
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 1
Disturbing Permit and all building permits issued in connection with the project covered by the application.
Name of Business: Name of Applicant:ALAN STERN
Mailing Address: 5925 RANCH LAKE DR. MAGNOLIA,TX, 77354
Street address: 5925 RANCH LAKE DR. MAGNOLIA,TX, 77354
E-mail address: [e-mail]
Telephone: Cell:832-5154655 Fax:
Name of Landowners)of Record. ALAN STERN&BETSY STERN
Mailing Address: 5925 RANCH LAKE DR. MAGNOLIA, TX, 77354
Recorded in Deed Book No: 4813 Page: 1312
IU. (;,,tud�i lttf��nn.ui�m-A;,,ri}t I .:r, 1,tnt
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: WYATT EDSEL
Mailing Address: 104 Hiawassee Ave, Black Mountain, NC 28711
E-mail address: [e-mail]
Telephone: fi ° Cell: 828-707-6120 Fax:
1 Signature: i ....) '
Date: ,€
l.. Curtitic.1t1.0t
I L 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: ALAN ST R Title: OWNER
Signature: Date: �/ r7 '-',202,21
•i= ,a Notary Public for the County of Yg5O�
State of M�C\�90.n ,hereby certify that { tvit S'�ei personally
appeared before me this y and under oath acknowledged that the above form was executed by him and is correct to the best of his
knowledge and belief.
i 1
a Witness my hand and seal,this 1 1 day of O t,.,)v r ,20 auk
4 DANIELLE REEVES
Notary Notary Public,State of Michigan
County of Baraga
My Commission Expires OU\CS '-0-io My Commission Expires June 5,2030
Acting In the County of Baraga
.DI'Fl('E Review Fee:S Permit No.: Check No:
USl 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.