HomeMy WebLinkAboutWPO201800088 Application WPO VSMP 2019-12-22CM
LMM
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: Pantops Corner
(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 0 No ❑
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County Fite Number: 11'(,PC) 2 U 18 00 0 (to be provided by the Countyfor new 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 Prope 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.
07800-00-00-005AO Pantops Corner LC
Tax Map & Parcel Print Name of Property Owner Signature of
07800-00-00-005BO Pantops Comer LC 1. <' ! t, �i. '-�-- � 1 z,Gl rf .3
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Tax Map & Parcel Print Name of Property Owner Signature of Owner 'Date
07800-00-00-005EO Pantops LC t'' �Z i f j
Tax Map & Parcel Print Name of Property Owner Signa7ure weer Date
07800 00 00 058G1 Pantops Corner LC 1 J..J" 10 /24 t
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Contact Information for the Owner(s) to receive correspondence:
Print Name
Address
City
Daytime Phone �)
E-mail
State Zip
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R1 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 7.05
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than 10
$3,400
$1,700
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than 100
$6,100
$3,050
$450
100 and more
$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.
0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
R1 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
H F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
0 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 17407 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 22902
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 VVPO #
Fee Amount $ Date Paid By who? Receipt # _Ck# By;
In
RECEIVED
JAN 2 2 r
COMMUNITY
DEVELOPMENT