HomeMy WebLinkAboutWPO201900016 Preconstruction Form WPO VSMP 2019-05-28 ALn,.
Request for Pre-construction Meeting and Grading Permit 4vascro
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Approved Plan Number: WPO- woo ant?-COo/6 •
Approved Plan Name: 1fl flee, upio,J 'zeta btcS,.vJ C SCoi,ed `a,,.td/ ric.,J
(Plans must be approved prior to a pre-construction meeting)
Bond approved date:
(Bonds must be approved and posted prior to a pre-construction meeting or permit)
Responsible Land Disturber:
Print Name: /jeUi,w) s „Eck 41-
State Certification Number: O\ O
Address �+1 _ - /� l/
City C�' N()r-}2,0At klLe: State Zip
Daytime Phone( ) E-mail
Primary Contractor: k(�(\ \ l t�C �t
Print Name kctt ,l�V. `�C'\. CJf.3.- _VAC\ 1
Address `�` \ cCc- VI\VA cc) , �•�
City ,(' eQ�°(�an 1 State VJ - Zip d-O
Daytime Phone( ✓ )t S rP `f E-mail CZ 0 0c0C-1 1 t C - I-Co p\
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Permit Issuance and First Year Maintenance Fees: (Request must include payment) ytti\-- '`u—J
Total acres proposed to be disturbed is contained on the approved plan and application: CA. FXSeticto)d.v t.
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VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
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 of 3
Person(s) to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
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?
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7/1/14,Revised: 8/29/14 Page 2 of 3
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VIRGLXIA DEPARTMENT O
ENVIRONMENTAL QUALITY
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Phone and email address will only appear if the certificate holder has granted permission to display this information publicly. '
Shifflett, Kevin Thomas
Stanardsville, VA
Certifications: -
• Responsible Land Disturber (RLD)#RLD09628 - Expires 05/09/2021
Page: « 1 »
For assistance with the Certification Accreditation Tracking System(CATS)please email certification@deq.virginia.gov(mailto.certification@deq.virginia.gov)or telephone(804)698-4375.