NCC221668_FRO Submitted (3)_20220429

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY/
PLANNING & DEVELOPMENT OWNERSHIP FORM FOR AN
�-. [phone] - Planning lnio@suncombecounty,org
www.buncombecounty.orgiplanning EROSION CONTROL PERMIT
INSTRUCTIONS: All sections must be completed, Section E must be CASE NLTARBER:
completed in the presence of a Notary Public.
PIN (Numbers): See attached supplemental information form Project Name: Stone Ridge S '-vismon
Latitude: 35.584333 Longitude:-82.714042 Amount of fee enclosed. S 1,050
Project Location - Highway/Street: See attached supplemental information form
Proposed Use: o Single Family Residence o lllalti-Family ❑ Yacation Rental ❑ Ccrmllrer4:ial/Industrial/Other ❑ Other
Proposed Disturbed Area (Include offsite borrow and waste areas): 2.00 acres)
B.
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 finaucial responsibility and ownership". This statement shall be signed by the person
tuiancially responsible for the laud disturbing activity or his attorney in fact. The undersigned states that he/shc 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
wet I 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: Alro Way, LLC Name of Applicant; Vladimir Grebenyuk
Mailing Address: 2348 Smokey Park Hwy, Candler, NC 28715
Street address:
E-mail address: [e-mail]
Telephone: Cell: 828-242-1879 Fax:
Name of Landowner(sl of Record: Big Hills Construction LLC
Mailing Address: 120 Dogwood Rd, Candler, NC 28715
Recorded in Deed Book No: 6050 Page: 1531
D. (-,on tact Inforn iation -North Carolina Agent (HApplicable)
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 afaremenrioned project.
Name of Agent:
Mailing Address:
E-mail address:
Telephone: Cell: Pax:
Signature: Date:
E. Certification
I, the undersigned, attest Chat l am the financially responsible party or an autborized representative with signatory authority for the
fmancially 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
Ordnance 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: K Title:fGC, .,'r,r2 LG C
Signature: -- Date: O / 2-a
[,J [l 7_ QN/(y, _�.(Il a Notary Public for the CountyLLo+f _ j��u .r e, r��p
State of % M D t` a hereby certify that U l� R{ k-t�4 1, personally
appeared befor�,nt�rt s y :WAftpder oath acknowledged that the above form was executed by and is correct to the best of his
knowledge t _ /y�j`%
Witness hi and seal, this • �ir�r—'`day of Gf/ 20
Notary
My Commission Expires 1� / L
OFFICE 'y vacw Fec: S � 1 pemlit No.: Check No:
USE ' ''
's, ii' - - Received by Date I slued:
The County of Idaxp)n iq# A'fscriminate on the basis of disability, in the admission or access to, or treatment or employment in,
its programs or activ164dA.' *Pq'uests for approprime auxiliary aids and services, when necessary to offer a person with a disability an
equal opportunity to participate in or enjoy the benefts of County services, programs, or activities, may be made by contacting
Buncombe County Erosion Control, [phone]. Buncombe Conntv's TDD number is [phone].