HomeMy WebLinkAboutWPO201800059 Preconstruction Form 2019-08-08Request for Pre -construction Meeting and Grading Permit ova``
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from Albemarle County '3; A��;
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Approved Plan Number: WPO- 2V17-000 q DEQ Permit Number (if applicable): VAR -
Approved Plan Name: UyA V-2,_LZA1 to,—Tj�ay"-i�, eo C X_,-
(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: 5f- e_1
State Certification Number: _�L� b ( Z Z i
Address '( -7 13 — 21 ' A W D :j�M �y
City �1�i2�!3> ��Ltk/i�� / State� A Zip Z(yLOT
Daytime Phone Nb(� I q?t/ E-mail
Primary Contractor:
Print Name CV L2 1�
Address 1-71
City State V'A Zip
Daytime Phone t " l) �(��' �� D E-mail S� {� t Li�(G� (�a �JT71 ��> �J Cam• (�GpV, ) i�i�
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.
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7/1/14, Revised: 8/29/14, 10/18/18 Page t of 3
Person(s) to attend the Pre -constriction Meeting:
Names (tvne or Dint) Firm Contact Number or email
/a. coo 1'Ql v V--1j LWb
SIJr7�lA Sc�Y On LF�,(, • loi10
WfAt:: y)y • 531•-7337
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, 10/18/18 Page 2 of 3