HomeMy WebLinkAboutWPO201900057 Application 2019-12-16Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: Proffit Road Townhomes North
(The nante should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 9
Is this a revision or resubmission for review? Yes ® No ❑
County File Number: W PO '011.0005 % (to be provided by the Countv.lbr new applications)
The following are required elements of new applications Lf om code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for a» v
submission.
R A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT
TO BE SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I hereby certify that all requirements of these plans and permits will be
complied with, and I have the authority to authorize the land disturbing activities and development on the subject
property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits. n — A
032AO-02-00-00200 Albemarle Land Development LLC
Tax Map & Parcel Print Name of Property Owner
Tax Map & Parcel Print Name of Property Owner
Tax Map & Parcel Print Name of Property Owner
Tax Map & Parcel Print Name of Property Owner
Contact Information for the Owner(s) to receive correspondence:
Print Name Brent Hall
Address 1949 NORTHSIDE DR
City CHARLOTTESVILLE
510
of
Date
Signature of Owner Date
Signature of Owner Date
Signature of Owner
Date
State VA Zip 22911
Daytime Phone UM t l(V �7q I I E-mail brent@hallsautobodyinc.com
J
7/1/14, Revised: 7/10/14, 1/7/14 Page 1 of 2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 5.60
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
S20
I and less than 5
$2,700
$1,350
S200
5 and less than 10
$3,400
$1,700
$250
10 and less than 50
$4,500
S2,250
S300
50 and less than 100
$6,100
S3,050
S450
100 and more
$9,600
1 S4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
® C. Registration Statement on the official DEQ form.
O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
a E. Stormwater Management Plan satisfying the requirements of code section 17-403.
5A F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
,JA ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
NA ❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Keane Rucker
Address 912 East High St
City Charlottesville
State VA Zip 22903
Daytime Phone (434) 299-9843 E-mail keane@shimp-engineering.com
*when applications and plans are reviewed, but not approved, and a response to comments is not received within 6 months
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY wPO #
Fee Amount S Date Paid By who? Receipt # Ck# By:
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