HomeMy WebLinkAboutWPO201600082 Preconstruction Form 2017-09-06 84,„4%
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Request for Pre-construction Meeting and Grading Permit
from Albemarle County 1 gr
Approved Plan Number: WPO-,,,0 I 6 0 C ` )Z
Approved Plan Name: cJ lk .Sfr�,-2. — (a Mill erod) 4 Cf nro471------
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: A¢ I a`/' .:10 �d 0 • �
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: I,
Print Name: : S 4 1,1 k� Q - , ` , ,
State Certification Number: ' t6 7J %(L7
Address z i' A f-V'4 <-5 f!'$ t C I , . ,
City I e i b t N,5.4'(1 f V fr Z`Z- j r State Zip
Daytime Phone ) C0 Ci rZ7 ZE-mail
Primary Contractor:
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Print Name f j _ C ! •�.r�
Address )I. Q!'r.0 `� ` ,
l V ll 0 1
� 1 Q5v� iiQ.- State VP---
City l Zip 2,.LZY0
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Daytime Phone��! /1'Qi� �[/��� E-mail k k(�.�
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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
f,-7/ ,1 and less than 5 ("' $594.09
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 Page 1 of3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
V.-_ 4 !1 42g, (dal
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
r .
E. Randall Ralston PC, Fiduciary Blue Ridge Bank 1 579
943 Glenwood Station Lane Suite 101 17 W.Main St
Charlottesville,VA 22901 Luray,VA 22835-1230
434-817-1040 540-843-5221
DATE 9/6/9017
68-237/514 I
PAY TO THE
ORDER OF County of Albemarle $ **594.00
Five Hundred Ninety-Four and 00/100*****,r*********************************************************************,r*,r*******,DOLLARS `5
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County of Albemarle
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MEMO ��
Grading Permit -
1:05L40.237-21: 200 213 71" L579
County of Albemarle 1,10 925
Department of Community Development � /� , ,
PH: (434)296-5832 DateXill )I,t'6 1�i
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RECEIVED FROM: i'. P i i,r I L; '• • 111 I f t l;ie., i II - 1 I
f t '% '✓ �t �f
' AMOUNT: Ilifi'.s i iii1 ii i � 's l.1'fmf 1('Xi ) ; �.1✓lf (1.{ f$t r 77, -..._ - $ ,,)11 4., t-
AV
307 308 324 •._ / 1-• ! 510 ,v
cash'
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For: `
/!1'�.t. �r�(�� f(1_ 1`� • - credit Ord
By :.! r-.- r i 1L-,r..'•
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