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Home My WebLink AboutWPO201800085 Application 2018-11-07Albemarle Ounty CommCharoftes Development Department 4{31 Fa�ntireRoadGharlottesville.�,+A229Q2-4pa�6 : {434) 29-3-5332 Fax : j43411D72-412E Planning Application 14 ` `•.r PARCEL OWNER INFORMATION TMP 018O0-00-00-O34F1 Owner(s): LICK MOUNTAIN LLC Application # WP0201 800085 PROPERTY INFORMATION Legal Description Parcel G Magisterial Dist `White Hall �± Land Use Primary Unassigned Current AFD Not in A/F District + Current Zoning Rrimar{ Rural Areas T APPLICATION INFORMATION Street Address Entered By .. aJennifer Pritch _..—. � Application Type `Water Protection Ordinnces � .__1-_ ..,.-e .. __ -1111111.11__ . i 11r13120i6 Project TMP 18-34F1-C Residence - VSMP Received Date 11J07/18 Received Date Final E= Submittal Date tT/13f 18 Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal ,Ad SUB APPLICA Stormwater Management/BMP Plan ! 11/13/18 ......._.. ........... Erosion and Sediment Control Plan 11/13/18 !§APPLICANT / CONTACT INFORMATION ntactTvne I Nattse I dress t'ifirState rin �- Phas--- n ' TPhnn C 11 ower+cr Appkart LICK MOUNTAIN LLC P:0 BOX 331 ': FREE UNIOWA -440 ' 4142494555 t ...... .. ......... . �? 'tact IUSTIN SHIMP 912 EAST HIGH ST CHARLOTTESLILL 22902 4342275140 Signature of Contractor or Authorized Agent date Virginia Stormwater Management Program (VSMP)�-� Application for Albemarle County �/>';,,I Project Name: TMP-18-34F1-G Residence (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No Is this a revision or resubmission for review? Yes ❑ No 91 County File Number: (to be Provided by the Count} -for netir applications) The following are required elements of new applications [from code section 17-401]. For revisions or amendments, please indicate which items are being amended. Signatures must be provided for any submission. ® A. Signature of the 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 Iand 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. / f 18-34F1-G Tax Map & Parcel Lick Mountain LLC Print Name of Owner ignature 6Poi k Tax Map & Parcel Print Name of Owner Signature of Owner Date Tax Map & Parcel Print Name of Owner Signature of Owner Date Tax Map & Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owner(s) to receive correspondence: Print Name Mark Lyons Address PO Box 331 City Free Union VA Zip 22940 Daytime Phone (434) 249-0565 E-mail mlyonsivy@gmaii.com Revised 07/24/18 Page I of 2 p ® B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 3.07 Acres to be disturbed Total Fee Fee Due with this Application Fee with Transfer or modification of permit Lessthan 1 $290 S145 $20 1 and less than 5 $2,700 $1,350 S200 5 and less than 10 S3,400 S 1.700 S250 10 and less than 50 S4,500 S2,250 S300 50 and less than 100 S6,100 $3,050 S450 100 and more $9,600 $4,800 S700 For (minor) amendments to an approved plan; $200 per review Variances; S 150 Mitigation Plan; $150 ® C. Registration Statement on the official DEQ form. 21 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® 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. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. 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 uny supporting documents. Professional seals n7ust have original .signatures. Additional information if not provided on plans and docionents: Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent) Print Name Justin Shimp Address 912 East High St. City Charlottesville State Virginia Zip 22902 Daytime Phone (434) 227-5140 E-mail justin@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 1?SF. ONLY �yINTO ti 9 Fee Amount S 135c)— Date Paid 3 I'6 Fay who? j.16Y-- / i0' Inn Receipt 9 Revised 07/24/18 Page 2 of 2