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Home My WebLink AboutWPO201900002 Application 2019-01-14Albemarle Counhl Planning Application *4000 Communitti Development Department 4D1 t' tire Road Charlottesville, VA 229D2-4596 1434t 295-5632 Fax : 1 434, 972-4126 TNIP1 046B4-00-00-00400 Owner 5): JA-ZAN LIMITED PARTNERSHIP Application # 1 WP0201900002 tOPERTY INFORMATION Legal Description FOREST LAKES TRACT VI Magisterial Dist. Rivanna i _ Land Use Primary Residential -- Single-family (inci. modular hames Current AFD Not in Af F District Current Zoning Primary C1 Commercial (APPLICATION INFORMATION Street A�ddress ( I Entered By Application Type 44/ater Protection Ordinances � � Judy Martin 11 111'142o19 Project laffsite Staging/Stockpile Hollymead Dam - VESCP Received Da_te 01/14�19 Received Date Final Submittal Date - Total Fees 150 Closing File Date — — Submittal Date Final Total Paid I 150 Revision Plumber Comments Legal Ad ;SUB APPLICATION(s) Strbpplioatio—Crrrrser t I I APPLICANT j CONTACT INFORMATION C ntactTTypq J ldarre , _-- stress _ CityStat —Zip Phone Pfior►gCell a rro' � srt .)A-ZAN LIMITED PARTNERSHIP �..i P O BOX 9035 — — i CHs.RLl7TTES'VILL 12i906 s................... ... .... .... _�er3a C:rt--.-• MIKE CA.RMODY 7610'0LL.GE HIG H 1A Ae CONCORD,`aA. :4349932215 �r+ er _•rt� JEREr*Y L. FOX 172 SOUTH PANTOPS DR„ CHARLOTTESOLL _' �911 4349798121 Signature of Contractor or Authorized Agent Date +u.+° `0W Virginia Erosion and Sediment Control Program (VESCP) Application for Albemarle County This application is only to be used for projects exempt from the Virginia � pP Y p j p g' Stormwater Management Program, VSMP, and the DEQ General Permit) Project Name: OFFSITE STAGING/STOCKPILE PLAN FOR HOLLYMEAD DAM WP0201800039 (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No 0 Is this a revision or resubmission for review? Yes ❑ No County File Number: (to be provided by the Countyfor new applications) The following are required elements of new applications jfrom code section 17-4011, For revisions or amendments, please indicate which items are being amended. Signatures must be provided for any submission. 0 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 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. 46B 4-4 �L C �4ttincb L �v L,,�aZ iii/i Tax Map & Parcel Print Name of Owner ig ture mer Date 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 MIKE CARMODY Address 7610 VILLAGE HIGHWAY City CONCORD State VA Zip 24538 Daytime Phone (434) 993-2214 F-mail MCARMODY@BURLEIGHCONSTRUCTION.COM 7/1/14, Revised: 7/10/14, 1/7/15, 10/17/18 Page 1 of im A All Fees [Code section 17-207] Total acres proposed to be disturbed 0.0 Acres to be disturbed Total Fee Less than I per review More than 1 $360 per review For amendments to an approved plan; $200 per review Variances; $150 (per request) Exceptions; $240 Mitigation Plan; $150 Construction Record Drawing; S300 Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ D. Mitigation Plan satisfying the requirements of code section 17406 for any proposed disturbance of stream buffers. ❑ E. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ F. 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 JEREMY L. FOX Address 172 SOUTH PANTOPS DR. STE. A City CHARLOTTESVILLE State VA Zip 22911 Daytime Phone (434) 979-8121 E-mail JFOX@ROUDABUSH.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 $ `-)O ' V 3 Date Paid I -1 By who? b V I Receipt # �' �l i�``I Ck-# 1 t� By:� 4 f�S�61, 7/1/14, Revised: 7/10/14, 1/7/15, 10/17/18 Page 2 of 2