HomeMy WebLinkAboutWPO201700047 Preconstruction Form 2018-06-20 Request"for Pre-construction Meeting and:Grading Permit: 4-71
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from Albemarle County
Approved Plan Number: WPO- Z&Ll 0CD0 tri
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Approved Plan Name: crI4,21ocCOV 0-16c-�•.Z L)G i -" Q.in I ep IQC�
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: r`X../.7 7,1 X
(Bonds must be approved and posted prior to a pre-construction meeting or pei•nut.).
Responsible Land Disturber:
Print Nanie: C C; I Z f
State Certification Number: "P .) 03 b"G
Address "? 17-11'S L d n
City v' >/ 5:.10&"0 State V Zip 7 2 ci $0
Da-yttiniePhone(5110) q G 4- 017 0 . . E-mail.. L,' . " . ...
Primacy Contractor:
Print Name L:nGo -- ZftG
Address I t ( LA n ..
City hfa I nt{ f •State VA-. Zip
Daytime Phone(5-W0) qyk- 037G E-mail 1;Aca saN/'_ QU. rc,i C t - 1
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:
`vSr ir: •
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
For plans exempt from VSMP,VESCP fees were paid with the application:
Revised: / 1 71?,114, 8/29 l4 Page," „ of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
c.S .(c:.k-z[e2 Lnco Twit,. uxco .c.Q.-CtvuccSb.Me
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The second part of the application fee is regzlired to be paid with this request: .This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who?
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