HomeMy WebLinkAboutWPO201800046 Preconstruction Form WPO VSMP 2018-08-14 Request for Pre-construction Meeting and Grading Permit 14
from Albemarle County IN, CV-
Approved
Approved Plan Number: WPO- �,��$ 000 Lt
Approved Plan Name: /-(A1'*L.AJ /2 -PA-L- ,S (.49,T
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: / Ilujus 1- `
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: Nn
Print Name: lam"Qt,✓ /I t 411- 7/
r
State Certification Number: 40 to (
Address / Q I V0 wNS 74--A
City 6111-070&S State 141-- Zip a, /,/
Daytime Phone( V3y R(eI --/S G D E-mail Iced/l,( le(/k, jyvtO,s / , cowl
Primary Contractor:
Print Name a hit-77/J 4 l/
iG ,,23.12 1 O i (td,.7 4
Address / 0 q.24 g.p(,.)pJI 6-/d p "--a49-4
City a/1i0 `( Q&S State VA Zip VW/
Daytime Phone(73Y 4g/—/ [ i 0 E-mail aka- [p Ot!i1 @ yY1Gi,i `. COYfl
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
t/ 1 and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised: 8/29/14 Page 1 of3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
&tan 111/q/tA"l13 `t-10 -1Set0
/L r o64: L 8vss-w.0/3 eg_ "toy-9a,9-3 936
b h o I ei G s �e cD
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/1/14,Revised: 8/29/14 Page 2 of 3
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