NCC221499_FRO Submitted_20220418

BUNCOMBE COUNTY
PLANNING & DEVELOPMENT
[phone] • [e-mail]
www.buncombecounty.orglplanning
INSTRUCTIONS: All sections must be completed. Section E must be
completed in the presence of Notary Public.
FINANCIAL RESPONSIBILITY/
OWNERSHIP FORM FOR AN
EROSION CONTROL PERMIT
CASE NUMBER:
PropertyA. Existing t
PIN (Numbers): 0619-xx-6353 Project Name: Brooks Cove
Latitude: 35.6239 Longitude:-82.3028 Amount of fee enclosed: $ 7,150(s525rdk(u,bM acres
Project Location - Highway/Street: Bnx�ks Cove Road
Proposed Use: ❑ Single Family Residence ❑ Multi -Family ❑ Vacation Rental ❑ Cominerciallhrdustr-ial/Otiler o Other
Proposed Disturbed Area (Include offkite borr-aw and waste areas): 14 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 ofa 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: Windsor Built Homes, Inc. Name of Applicant: Scon street
Mailing Address: 40 west Brad Sireer, suite itxl, Greenvale- SC 29601
Street address: 41) west Broad Str %Sane 500, (3reenville, SC 29601
E-mail address:
Telephone: [phone]M7 Cell: Fax:
C. Lrndowner(s) of Record
F
of Landownerts) of Record: Windsor Built Homes, Incg Address: 40 West Broad Street, Suite i00, Greenville, SC 29h01
ded in Deed Book No: 6071) Page: 1642
Contactr
Section 26-228(b) ofthc Buncombe County Soil Erosion and Sedimentation Control Ordinance: "Ifthe 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 proiect,
Name of Agent: Riley Hoke Smun
Mailing Address: 743 Cardwell Lane, Fletcher. NC 28732
E-mail address:
Telephone: (x64) i7 1-4037 Cell: (Slaq> SO 3 -153014 Fax:
Signature: 14 Date: II tl 'jdQ1
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: Riley Ho�nuri Title: Secret:vy)
Signature: Date: t l I t t/ z..zf
T, ScrdnIr13C L.C-%at!e. a Notary Public for the County of \Iti�iC.
State of 5%nt J CA 'ti t lna hereby certify that Q'• e4 I&E - smarms personally
appeared before me this day and under oath acknowledged that the above fori was executed by him and is correct tot of his
knowledge and belief. ,``,,�lE vLfIC.'t
Witness my hand and seal, this I k ch __day of �] \1 In ex-20Y P�
Fk
Notary Q�� •
t Z MY 5.
My Commission Expires 0 CommisslRq _
�X IrfSS
OFFICE Review Fee: $ Permit No.: Check N (p 01/09/2027 ; • �
'• � USE Date Paid: Received by: Date Issued: / •.". .•% •• �
The County gf'Bunconthe does not discriminate on the hasis af'disahiliw in the admission or access to, or treat» i lite 1 ahi' <11cNTt in,
its programs or activities. Requests for appropriate auxiliary aidv rend services, when necessan, to offer a person wi� i lill. all
equal opportunity to participate in or enjoy the henefils qf' County ,services, pr•ogrmns, or activities, may he made by contacting
Buncombe County Erosion Control, [phone]. Buncombe County's TDD number is [phone].