HomeMy WebLinkAboutWPO201800091 Application 2019-03-27Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: Lewis and Clark Drive Road Extension
(The narrre should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No Fill
Is this a revision or resubmission for review? Yes ❑ No 91
County File Number:
(to be provided by the Counlyfor new applications)
The following are requit-ed elements of new applications Ifi-om code section 17-401]. For revisions or
amendments, please indicate which items are being amended, Signatures must be provided for any
subin ission.
® 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 u he property as required to ensure
compliance with the approved plans and permits.
03200-00-00-006RO University of Virginia Foundation
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Tax Map & Parcel 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 con•espondence:
Print Name Todd Marshall
Address P.O. Box 400218
City Charlottesville State VA Zip 22904
Daytime Phone (434) 924-2569 E-mail tmarshall@uvafoundation.com
7/1114, Revised: 7/10/14, 1/7/14 Page 1 of
41 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 6.87
Acres to be
disturbed
Total Fee
Fee Due with this
Application
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 (minor) amendments to an approved plan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
® C. Registration Statement on the official DEQ form.
Z D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
Ll 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.
0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ 1. 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 playas and documents:
Name of a Contact Person for correspondence (usually the plan prepares, consultant or agent)
Print Name Craig Kotarski, PE
Address 608 Preston Ave, Suite 200
City Charlottesville
Daytime Phone (434) 327-1688 E-mail
State VA Zip 22903
*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# By:
7/1/14, Revised; 7/10114, 1/7/14 Page 2 of 2