HomeMy WebLinkAboutWPO201500026 Preconstruction Formpf Ai_t•ji
Request for Pre -construction Meeting and Grading Permit
from Albemarle County
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Approved Plan Number: WPO- ac 15 -0 r, t'o
Approved Plan Name: irk 5 Ro Sode-wool—',
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name: Sri rn t
State Certification Number: 1Z ) l
Address--]
L E 1 is La n e,,
City
UQ r-o
State V✓-7 Zip 3,�;0,96
Daytime PhonetZ) g9gQ37Q E-mail t i r)Co 1 /)G
Primary Contractor:
Print Name
Address t Lane,.
City
State V Zip 0 90
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Daytime Phon4 ) q uq p a,'7Q E-mail 1 oco tine. wmca-st nof-
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
$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
$2,112.00
For plans exempt from VSMP, VESCP fees were paid with the application.
7/1/14, Revised: 8/29/14 Page 1 of