NCC240604_FRO Submitted_20240301

BUNCOMBE COUNTY FINANCIAL RESPONSIBILITY!
4;10
PLANNING NC & DEVELOPMENT OWNERSHIP FORM FOR AN
pze)2sa�ua olmninpinroAetrnoon>e�'uexy`t° EROSION CONTROL PERMIT
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INSTRUCTIONS All sectirns must be c-ompktc4.Section E must be CASE NUMBER:
convicted in tAc prescrwe of a\wary Public
\ I \,''rn::Fronts h. Inlnrni bruin
PIN(Numbers): _9135312307 Project sane:803 Jupter Ro8d
Latitude: 35 7611732435594Q Longitude: -82 596016760041 Amount of fee enclosed:S 1350
Project Location-Highs,asNtrect: 803 Jupiter Road.Weavervslle.NC 28787
Proposed Use: 0 Siaj;k Faintly Rri,Jrn,r n Alulri-Faintly a Vik ar„A Rrnt:al r(bmmrr,tut InjutniobOriler ❑Otfcr
Proposed Disturbed Area(include offish-borrow and wow*rear): 2 acre(s)
B Cnni.ist Inforntaunn—Finanualh Rc-> mull-Pciutn
Sc::taa:0-2:Nttl 01 I:e blur.,_ml•c(,•,.nt. S:,;,I:o.,:•r.a-.1 ;J:DV nittum Control(kdinance. "Erosion control plans shall be
aceore anwd by a noeanred statement of financial responsibility and osinershrp' This sutcment 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 dtsturbing acuity described in this application and acknowledges receipt of a copy of the County of
Buncombe Soil Erosion and Sedimentation Control()reiterate and that he'shc has thereby been advised of the requirements therein as
well as the penalties and resources availabk to the County in the cscnt of violation of the Ordinance,including revocation of the Land
Disturbing Permit and all budding permits issued„1 connection with the project covered by the application
Name of B:suSss Hardcastie Property LLC Name or Applicant Don Walters
sliding Addr tt 115 Travelers Way,Mars Hi,NC 28754
Sint,,44,ess 115 Travelers Way,Mars Hi,NC 28754
t-m,s,1,da,.ett [e-mail]
Te ter'.m: 302-563-1953 Cell: fan•
C 1,,m1.....ntr(•)of Rrl 'RI
Name of Lar'4awnees)of Recent liarOcasue Property LLC _
Ma;hng Added„, 115 Travelers Way.Mars Hill,NC 28754
Recorded:n Deed Book No: 6355 rage. 784
D. Contact Information—North Carolina Agent ell Applie.rbk,
Sc.'.tc i 2b._'.,:,,el L`,c li..r.,_';t,c l our..:y se::c rc.icr a-.4`(vurw'.tiL:,n C'orerol Ordinance -If she prison financially responsible
is not a resident of North C'a:otiliaa.a Numb Carolina agent must be designated in the statement for the puapou of receiving notice of
comakance or non•cocnptlon t w ith tS.e plan.the Act.this ordinance.or rules or orders adopted or issued pursuant to this ordinance.'
The person notes!below;s the d:sigtated 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•matl address
Telephone Cell Fax:
Signarurc. Date:
I,the undersigned.attest that I am the finamially responsible party or an a,abortred representative with signatory authority for the
financially responsible pang.resporaublc for the construction activities and tearntcnance 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 rc rsirements therein as well as the penalties and resources available so 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' UrSTLE 9 O N uc-De..)iii A lArn.iTrlk. ,L&AG1j - r
Signature _ r Date: 1/2-3120;41- o•'..ss p, B 13/44'r'•
1.ShaWn a s .a Notary Public for the County of Vic 4.S•CiftQ� C�••
p . 4
State of N C,✓t1n CC.YatJ r�P .hereby cent fy that £ td W N_t 1" =y j�cul ly-R k \t
appeared before me this day and under oath acknowledged that the above form was executed by him and is cerrcct fo the best of his
knowledge and belief may/{( - O
Wroness my hand and scat,this 2 i day of J el/1 .20 Z �' e 2
`E P(JBO
Notary'%1.3.. '.. vj�- • : ,lc;..
My Commission t_spites V !� ',rrrraa'O'7 CO' `vv�`v,
trial at-rii 11►snit
OFFICE Review Fee:S Perms No heck No
LSE Date Pad: Received by. Date Issued: J
The County of Bunruaihr does Our dm not:nut,on the haus of disability in the admission or a.i fit to,or treatment or employment to
its programs or itctnoies.Requests for appropriate autihan aids and arnices. whin netrstar,to ofkr a person wire a disability an
equal opportunity to participate in or enjoy the benefit'of Coumh services,program'. or activities. may be made by contacting
Buncombe Conan Iranian Contra!,( 28)25Q.4Rlt Buncombe Couaty's TDD number a(.428)250.4001