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BOND INSPECTION REQUEST
APPROVED PLAN# (JQD Rots-- O0/04
PROJECT NAME: a-4to/a .ltr+/GONN.t.E - t Oio- 0G
(As listed on the approved plan)
This is to request that an inspection be performed by the County. Where fees are assessed,a fee is required for
each inspection. Please check the inspections requested.
1 VtiSMP/VESCP Erosion Control,Stormwater Management and/or Mitigation per
Water Protection Ordinance secrion 17-207&208 S250
0 Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435 and 14-438; S269
0 Water&Sewer per Subdivision Ordinance section 14435 S269
IN3Wdr
0 Site Development Performance bond(Incomplete Site Work&Landscape Maintenance) S301
TOTAL FEES igSete
Inspections for the purposes of bond reduction or release will require a separate fee for each bond.
Submit requests to: Department of Community Development,401 Mclntire Road,North Wing,Charlottesville,
VA 22902,Attention:Management Analyst- Phone 434-296-5832;Fax 434-972-4126. All roads and
stormwater facilities will require construction record drawings, inspection reports,and completion processes'
through VDOT or DEQ. Bonds will not be reduced or released without record drawings and inspection
documentation per the state requirements and county's published procedures. A minimum 20%of the original
posting is held until acceptance of all bonded improvements. For Site Development Performance bonds, if
landscape installation is part of the bonded incomplete site work,a request for reduction should only be made
once all site work is complete.
The revised estimate should be sent to; ',/
EMAIL: �QMea @CL J ¢+A/tTc n�bD �+ 2x a c “^wrila .CD
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OR REGULAR MAIL ADDRESS: Pa. 3ai - g9
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Signature of Owner/Developer
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Print Name Date
Revised 7/152014,7202015. 11/332015