HomeMy WebLinkAboutWPO201800063 Preconstruction Form 2019-09-10Request for Pre -construction Meeting and Grading Permit_
from Albemarle County — VSMP
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Approved Plan Number: WPO- 901600063
Approved Plan Name: &VQd.t.P"e , Byim _41r)Lqk 93(p -A3 9 4- a4o -a4-/+
(Plans must be approved prior to a pre -construction meeting.)
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name:
. lam,
State Certification Number: LUo4-,�.53
Address ��10 ad Wa
City O-)9_V_-b g-(SVk State Zip p(oZ
Daytime Phone *j oA+^-Q3b4 E-mail LUi U i elmd cr&. ,C� Gr)6_�, com
Primary Contractor:
Print Name
Address
city State Zip C
Daytime Phone A q73. 33 ,3a E-mail
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
7TR4.00
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
Annual Maintenance Fees [Section 17-208 of the Albemarle County Code] - Annual maintenance fees will be assessed in
March of every year this permit is active. Fees cannot be prorated after the first year of permit issuance.
7/1/14, Revised: 8/29/14, 8/28/19 Page 1 of
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?
7/1/14, Revised: 8/29/14, 8/28/19 Page 2 of 3
CRAIG BUILDERS UNION BANK & TRUST 22584
'P.O. BOX 6156
CHARLOTfESVILLE, VA 22906
68-316/514 August 27, 2019
PAY
TO THE
ORDER OF County of Albemarle $
63.80 =
Sixty Three and 80/100 ****** r*** t********** r**** r*******x* r* r******* a*************** DOLLARS
UNION BANK 2019 =
401 McIntire Road
Charlottesville, VA 22901 CRAIG BUILDERS
MEMO �r�_1 �I.RIZIIIIIMATI
�A\QJ V02258411' 1:05L4031F3,1: 85L785374113
CRAIG BUILDERS 22584
Pay To: County of Albemarle 08/27/2019 $63.80
Supplier: County of Albemarle Invoice 4: 146274 BEL4A.237 08/27/2019 $63.80
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RECEIVED
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COMMUNITY
DEVELOPMENT