HomeMy WebLinkAboutWPO201800072 Preconstruction Form 2019-08-22 • vtece✓1 CJ w.eca-ca
Request for Pre-construction Meeting and Grading Permit }-
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from Albemarle County
Approved Plan Number: WPO- c2 0 C9OO -7 DI
Approved Plan Name: "'. �Po1(1G1 S Ave_.
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: l)'Zl 770 L
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: ei-g--1 6 / L�
State Certification Number: Li a 3 6
Address P /io/`9 g N or/h5I C,1e- b/!
City &hark -It/soi l & State VA Zip 201/J1
Daytime Phone(-'4 ) 90 - I E-mail hran}-@ 9r..�ea, f kre /Y►a ev141, Coto
Primary Contractor:
Print Name C I/�/l s (�l'l ✓ ot7 ei')u s (_..-
Address /9Ll9 /V oilh 51 de_ A",
City Chai/(J7 j&6 VI I le_ State V rT Zip Dv--/)'
Daytime Phone 03/1 v/ r / 1 f E-mail brla j%t ne—(n elkkJ S ,Cd14')
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.
4-112 7/1/14,Revised: 8/29/14 Page 1 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
i)) /e/(1--y waa6 bwn f 2. ii3q- -,sift/
z y / 1- -- 63(1. .r)clove 1V -maks 3LJ - cCt- 59//
kean j-2-uc_k ki)01p e,,n)G , 43q - 473- a94/
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
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Fee Received
Received`bete
RECEIVED Received By
AU6 2 2 1ptg ----
COMMUNITY
DEVELOPMEN r