HomeMy WebLinkAboutWPO201800088 Application WPO VSMP 2019-08-21im
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Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: Pantops comer a /o rank Pohl
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes W No O
Is this a revision or resubmission for review? Yes [I No 61
County File Number: W p0 LOW 000 if (to be provided by the County for 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.
M A. Signature of the Property+ .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 Comer LC 1
1
'3 1 !Jf 1 L am'' Id l Zd l k
Tax Map & Parcel Print Name of Property Owner Signature of Owner D6te t
I
078004X0-00-005B0 Pantops Comer LC it t% 1A__ Ou h f
Tax Map & Parcel Print Name of Property Owner Sighatfure of Owner Date
07800-00-00-005EO Pa tops LC ) ? -t/ 7sZGl ! y
Tax Map & Parcel Print Name of Property Owner i caner Date
07800-00-00-058G1 Pantops Comer LC
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Contact Information for the Owner(s) to receive correspondence:
PriniName✓Slt;/l S►7 M
Address ram" y S{
city C hor l a f k s v. t �,�V* Z, Zk 0 State zip
Daytime Phone CLJW Z q 1 " ::4 72 Email , \ S41A IQ- 5,�%W%/l0 , CO41
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LWI
0 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 8.75
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
S290
$145
S20
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
S4,500
S2,250
S300
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; S200 per review 2S0 W. Ac /t6gG I Acr6* Sc
Variances; $150 (per request)
Mitigation Plan; $150
0 C. Registration Statement on the official DEQ form.
0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
0 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
0 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.
❑ 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 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 WPO
Fee Amount S Date Paid By who? W \X;AOQh Receipt * Cid1 ct- BY.—JY—__
Pee Received
Receied 0a
RECEIVED
Received By
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AU6 2 12019
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