HomeMy WebLinkAboutWPO201500025 Preconstruction Form Request for Pre-construction Meeting a:ad Grading Permit
from Albemarle County
Approved Plan Number:WPO- — a f* '
Approved Plan Name: /. pyofc),(412.,_
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to api e-construction meeting or permit.)
Responsible Land Disturber: �*
Print Name: A/ eVS
State Certification Number: F.t.. O 5-6.3
Address 1$O 6 1ReG.g c1Cs.
_._-..
City _gar rt:Sta
_ State r4 _-- zip 22Ta
Daytime Phone L Q_' "/(21 & i_. E-mail_i s&i&d r.s Jj +ft /
txi 7"tlt'�,.PtkY'41-%brDt,~�,'�,.C,�QYII.-�.,.
Primary Contractor:
Print Name I-0.r . i= C o._ o.__ t L c_ r w r
Address 5 tip\ t-k,tt ';2 0 cc,
City
State V A Zip 7-.S.Z'Z'$
Daytime Phone(3 09) 3 l > 757 3 L-mail .r. b ._ @9 \o._ �,.,
Permit issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained oil the approved plan and application: o -3 c i
VSMP:
Aores to be disturbed!ed
I pee Due at Grading Permit
Less than 1 _---
1 and less than 5 -
. SS94.00
5 and less than 10 $748,00
1-0-and less titan S0 S990,00
50 and less than $1,34.2.00
100 and more -_..;z. - -.-
sz,1 roo
For plans exempt from VSMP,VESCP fees were p tid with the application.
7/1/14,Revised:8/29/14 Page 1 of 3