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HomeMy WebLinkAboutWPO201900026 Preconstruction Form 2019-10-11 �OFAL% Request for Pre-construction Meeting and Grading Permit. to from Albemarle County—VSMP 441.10 1 i V 0oa / 1 v�nyria1� cyi:/Ir. Approved Plan Number: WPO- �� � � �� VA-RI Approved Plan Name:- VSMP ? tun -for W4wn (Plans inns(be'approved prior fo,pre-co'itsiructioi>nieetirrg)' (Bonds must be approved and posted prior to a pre-consfrnctio.1 permit.) Responsible Land Disturber: Print Name: Pa tti I M t c ttk.h e t -C r o u S -- State Certification Number: R 1--I)09 51 N Address a 80.0 Pc 4-te fsori Aw.e n t - 5 20 City i`iGk!`nor\A_ .,State VA Zip 232z..1 Daytime Phone(ON) 9 i cl - o 713- E=mail. p'S rr Ouse c.• (Q t 1e e, C i"+ 804 307 - yiag9 (celt� Primary.Contractor: Print Name Gt)i)ei^^An GxcaVrihr j LLL. - Address, 9 76 D a y yS w r, i o&-cA City, SwArcts S State V . Zip. a30a.1 Daytime Phone(540) — S 10 5 E-nail 30t)(4"ttin eKCcivak,r //c ,iv ;L. Permit Issuance and First Year Maintenance tees:(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 S594,00 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. -PVC Jgi11 • • Person(s)to attend the Pre-construction Meeting: Names(type or print). Firm Cofitfict Nuinber ortniail Pck v. KOOkee, Bv(4-30"7- 'PP 0- D ZA0 C.0.. livtnek• Gooamk^ E-gceiv a 15 SL/o 33va • The second part of the application fee is required to be paid IWO;:this-roquest, This fee-amount is; :FOR OFFICE USE ONLY Permit Issued Date By Am?. • • • • • 14 • • • I _•••In..,04 •••••••14 •••••