HomeMy WebLinkAboutWPO201700026 Preconstruction Form 2017-07-05 Request for Pre-construction Meeting and Grading Permit
from Albemarle County fift
Approved Plan Number: WPO- ZO\1r * MOO\
Approved Plan Name: ��0,,,1,,.,� `COW R,, s 1S\oak. G—1 j
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(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: 5 3 l - /5 / Z1) •
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: l_
Print Name: S 44kk C&t\s 0^
State Certification Number:
Address °I 00 (7.w. & 3
City C sd'`\,A.&.b\i \\, State V 14 Zip Z2P102„
Daytime Phone(W) 7 f 7Jf 1T E-mail C ‘k, jo W-(..A +� 11"—'
Primary Contractor: C1_ �/��,,
Print Name J7"'� /'►^'r 4e'1 k; 4
Address 1 0 /'T'Y...011". orb lkl,OtD
City 2A.b 0.• State \ ft Zip 2d0 c1 0
Daytime Phone(10) ¶4 M 5.000 E-mail eCt s bti„�j C, fin,. 4;..ti ,..
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
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
t1Pu Svl 0r S'AaNkQ,7 Ay() 915-- nIC:\y 0
koei.4-1 S nV a r�. ut:, ftQsitiAk temt fyn, c
1
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