HomeMy WebLinkAboutWPO201900006 Preconstruction Form WPO VSMP 2019-06-03At,
Request for Pre -construction Meeting and Grading Permit��'.:
from Albemarle Countyu:
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Approved Plan Number: WPO- a2 Of q — 0000 6
Approved Plan Name: 7 h e cpt/P.44^
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: /30/f g
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber: j� f
Print Name: 4 & Ui I `ar�n
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State Certification Number: c2 701 O to? 0 + O
? Address S'-
City l ' ' o y State V14 Zip
Daytime Phone (" 06 ' 06� E-mail "'"i( (p ct ��� r��ro� • ��
Primary Contractor:
Print Name
Address / <<'�"� y '�
City , ' A State // //� Zip 7 7
Daytime Phone ( 77 ` 3?i3�� E-mail �� C Q 4' Gl. t la/�� • C �''h
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 of 3
Person(s) to attend the Pre -construction Meeting:
Names (type or print)
Finn
Contact Number email
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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