HomeMy WebLinkAboutWPO201700028 Preconstruction Form 2018-04-26 •
I �
p1 ALb�,
Request for Pre-construction Meeting and Grading Permit � 11,''9�
from Albemarle County
R rE ,,
Approved Plan Number: WPO- 1 RO 17— 000 a S-
Approved Plan Name: 6 -PAH( Eo\rl Vc cd ememoi WPO VS(1 P
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: Jk/i g I (NA K;)w �i1 '�"
�e� eo cv, r),0)
(Bonds must be approved and posted prior to'a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: C O°(\+ Ac GASkrtA O 1-�- C
State Certification Number: 3 1'()3 Ifv
P I (
Address 17 13 A�,I fC,\ �'-Ve C-f
City 1 �O'� 1� 'I6 v{ L�� State VA Zip ,9 P\e7d a.
Daytime Phone(q-31 41' 1 - QQ U ! E-mail 5 e c COA tC-COAS"Acil-0v0, i\C-`f
Primary Contractor:
Print Name
Address
y
City ( State Zip
Daytime Phone( ) ! E-mail
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 ! i$63.80
1 and less than 5 $594.00
5 and less than 10 ) $748.00
10 and less than 50 (.$990.09
50 and less than 100 i 1742.00
100 and more $2,112.00
,
For plans exempt from VSMP,VESCP fees Were paid with the application.
C '
7/1/14,Revised: 8/29/14. Page 1 of 3