HomeMy WebLinkAboutWPO201500025 Application WPO VSMP 2015-04-20 Virginia Stormwater Ma agement Program (VSMP)
Application,for Albemar e County
Project Name: CMA PROPERT ES
(The name should e the same as it appears on plans)
Is this an amendment to an a proved plan? Yes 0 : No G31
Is this a revision or resubmis ion for review? Yes g No El
County File Number: wp 015 — 25 (to be provided by the Counity for new applications
The following are required ele ents of new applications[from code section 17-401]. For revisions or
amendments,please indicatew ieh items are being amended Signatures mist be-providedforlanyi
submission.
A Signature of the Prope Owner for each parcel: (Required with every submission or revision, NOT
• TO BE SIGNED BY AN AGENT OR CONSULTANT) :
By signing this application s the owner,I hereby certify that all requirements of these plans and permits will be
complied with,and I have 'le authority to authorize the land disturbing activities and development'on the subject
property. I hereby grant t e County of Albemarle the right to enter upon thelproperty as required to ensure
compliance with the appro,ed plans and permits.
45-173 CMA PROPERTIES (1-Po-ao
Tax Map&Parcel Print ame of Property Owner : Signature of Owner Date :
45-94B CM PROPERTIES
Tax Map&Parcel. Print ame of Property Owner Signature of Owner Date
Tax Map&Parcel Print, ame of Property Owner Signature&Owner Date
. Tax Map&Parcel Print ame of Property Owner. Signature of Owner: I Date
Contact Information for the •wner(s)to receive.correspondence:
Print Name CMA PROPERTI -PETE BORCHES
Address P.O.BOX 7823
City CHARLOTTESVILLE . I State VA Zi 22906
Daytime Phone(434) 962-6307 E-mail pborches@CMAcars.corn I 1
17/1/14,Revised:7/10/14 Page•1 of 2
El B. All Fees [Code section i.7-208]
For new or modified plans; Total acres proposed to be disturbed 4.71 AC
Acres:to be Total Fee : Fee Due with this Fee with Transfer or
: _. . :-: .disturbed . . . :- : . . . . : Application :. . modification of.permit. . . .. .. . .. : : . .
Less than 1 $290 $145 $20
1 and:less than 5 $2,700 $1,350 $200
5 and less than 10. . $3,400 . :$1,700 . $250 :
10 and less than 50 $4,500 $2,250 $300
50 and less than $6,100 $3,050 $450
100
: 100 and more. :. $9,600 . . . : .$4,800 : $700..
For(minor)amendments to an approved plan;$200 per review
Variances;$150
: Mitigation Plan;$150 :
❑ C. Registration Statement on the official DEQ form.
:® D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402:
IX E. ' Stormwater Management Plan satisfying the requirements of code section 17-403:
❑ F. : Pollution Prevention Plan satisfying the requirements of code section 1.7-404.
El :G. : Stormwater Pollution Prevention Plan satisfying the requirements of code:section:17-405 :
El H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers;
❑ I: Requested Variations or Exceptions as provided in code sections 17-407 and 408:
: 0 J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
:Provide 2 copies of all plans and any supporting documents: Professional seals must have original
signatures. .
Additional information if not provided on plans and documents:
Name of a Contact Person:for,correspondence(usually the plan:preparer,consultant or agent)
Print Name COLLINS ENGINEERING:SCOTT COLLINS
Address 200 GARRETT STREET,SUITE K
: City CHARLOTTESVILLE State VA Zip 22902
Daytime Phone(434) 293-3719 E-mail scott@collins-engineering.com.
*When applications and plans'are reViewed,but not approved,and a response:to.comments is not received within 6-months
from the date of county-comments;the application will be deemed withdrawn..Applications without valid owner's
signatures will.not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# _Ck# By:
7/1/14,Revised: 7/10/14 Page 2 of