HomeMy WebLinkAboutWPO201800016 Application 2018-12-10I
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Virginia Stormwater Management Program (VSMP) tf �
Application for Albemarle County
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Project Name: Birdwood Golf Course
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ® No ❑
Is this a revision or resubmission for review? Yes ❑ No FU
County File Number: WP0201800016 (to be provided by the Countyfor new applications)
The follom,ing are required elements of nen, applications f om code section 17-401]. For revisions or
amendments, please indicate nrhich items are being amended. Signatures must be provided, for any
submission.
® A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT
TO BE SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I hereby certify that all requirements of these plans and permits will be
complied with, and I have the authority to authorize the land disturbing activities and development on the subject
property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits.
75-63 University of Virginia Foundation L
Tax Map & Parcel Print Name of Property Owner Signatur ner J
m
Tax Map & Pat -eel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name Chris Schooley
Address PO Box 400218
City Charlottesville State VA Zip 22904
Daytime Phone 4( 34) 989-9752 E-mail cschooley@uvafoundation.com
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® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed N/A Amendment
Acres to be
disturbed
Total Fee
Fee Due with this
Application
I Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than 10
$3,400
$1,700
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than 100
$6,100
$3,050
$450
100 and more
$9,600
$4,800
$700
For tumor amendments to an a rovedplan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
❑ C. Registration Statement on the official DEQ form.
❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Craig Kotarski, Timmons Group
Address 608 Preston Ave
City Charlottesville
Daytime Phone 4( 34) 327-1688
State VA Zip 22902
E-mail craig.kotarski@timmons.com
*When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 months
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO #
Fee Amount $ Date Paid By who?
Receipt # Ck#
Isy:
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