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.
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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
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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?.
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