HomeMy WebLinkAboutWPO201700031 Application 2017-11-08Virginia Stormw7ter Management Program (VSMP) 'A I..
Application for Albemarle County .
f �ItCIN�P
Project Name: University of Virginia Foundation Golf Facility
(The Dante should be the saute as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No ED
Is this a revision or resubmission for review? Yes ® No ❑
County File Number: SDP2017-019 (to be provided by the Countyfor new applications)
The folloiving are required elements of neiv applications %from code section 17-401]. For revisions or
amendments, please indicate which items are being amended Signatures must he provided for any
suhmission.
M A. Signature of tLe Property Owner for eacli parcel: (Required with every stlhlilissiori or revision, NO"
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.
TM 75-63 - - Chris Schooley, UVAF
Tax Map & Parcel Print Name of Property Owner Signature
- 11/08/17
Date
Tax Map & Parcel
Print Name of Property Owner
Signature of Owner
Date
Tax Map & Parcel
Print Name of Property Owner
Signature of Owner
Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name Chris Schooley c/o University of Virginia Foundation
Address PO Box 400218
City Charlottesville
Daytime Phone (434) 982-3777 E-mail cds7c@virginia.edu
State VA zip 22904
7/1/14, Revised: 7/10/14, I/7/14 Page 1 of 2
® B. All Fcc z [Code section 17-208]
For new o: modified plans; Total acres proposed to be disturbed 4.24
Acres to be
disturbed
Tess than 1
Total Fee
$290
Fee Due with this
Aeplication
$145
Fee with Transfer or
modification of permit
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than-] 0
$3,400
$1,700
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than 100 1
$6,100
$3,050
$450
100 and more 1
$9,600
$4,800
$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.
C] D. Eros,— Sedime►at olitrol Plan '1
`�1i b the rCdtlil-onlVi'tts
Ell 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. Storinwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
.stream buffers. _
❑ 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 17422.
Provide 2 copies of all Plans and any supporting documents. Professional seals must have original
signatures.
-4dditional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Devin Keeler
Address 4805 Lake Brook Dr., Suite 200
City Glen Allen
State VA Zip 23060
Daytime Phone 8( 04 } 205-3321 E-mail dkeeler@dewberry.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 NVPO #
Fee Amoant $ Date Paid By wha7
Receipt ft Ck#
By:—
7/1/14, Revised: 7/10/14, 1/7/14 Page 2 of
RECEIVED
N" 9 - 2017
COMMUNITY
DEVELOPMENT