HomeMy WebLinkAboutWPO201900053 Application WPO VSMP 2019-09-16Virginia Stormwater Management Program (VSM
Application for Albemarle County I
Project Name: Eco hill
(fhe name should be the same as it appears on plans)
Is this a revision or resubmission for review? Yes IZ No El
County File Number: WPO 201900053 (to be provided by the Countyfor new applications)
The following are required elements of new applications ffrom code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for° any
submission.
2A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT
i 1, 17 1
11 � T 12
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.
06100-00-00-21000 Eco Village Holdings LLC
Tax Map & Parcel Print Name of Property Owner
'Fax Map & Parcel Print Narne of Property Owner
Tax Map & Parcel Print Name of Property Owner
Contact Information for the Owner(s) to receive correspondence:
Signature of Owner Date
Signature of Owner Date
Signature of Owner Date
PrintNanie—Ec- m tq3L(--j&W4S -IA C� . . . ................ 0 .................. ...........................................................................................
Address
City hrl�e !M State iII& ......... ......... ......... .....................Zp
Daytime Phone (� ` _ 6Z4- 1�05 E-mail V54 .. ........ ................................................................... _OM A! Lm. . .......... .
7/1/14, Revised: 7/10/14, 1/7/14 Page I of 2
0 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed . .104!. ................. ........... ....... -.
. .......................... - ........................................................................... .
Acres to be
. ........
Total Fee
Fee Due with
------- ---
Fee with Tran's'"f"er or
disturbed . .
. ........
"" ....... ...
Application
—$145-" . . ..... . . ........
modification of
. —$2-0 . .. . . ..... .
Ie's s'there' I
$ 2 9 0"
-Fand less an 5
— — ----- - .
$2,700
. . . ...........
. .. . ...... . - — - ------- - - --- - -------- -
$1,350
- - ------- . ...... .... . .............
$200
and i�ss )
R
$3,400
$1,700
$250
10 and less than 50
$4,500
. . . . . . . ................................ .
$2,250
. . ............. ....... -.- . . . ............. . .
$300
-SO end �sst�an—f06""j-",
'100
$3,050
........
$450
100 and more
$9,600
. . . . . . . . . .. ............................
................... .
$4,800
. ................... . .
............ .- . . .. ... I ......... -. .. . .. ...
$700
. ...................... .
For (minor) amendments to an approved plan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
0 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.
1:1 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
El Ja Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 co ies ofallplans 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)
..... . . . ................................................ . ..... . ...... . . . . ................................................... - - - -- . ... ... ... ...
FOR OFFICE USE ONLY WPO#—
Fee Amount S-1— Date Paid By who? Receipt # Ck# By:
. . . . ................. . .
7/114, Revised: 71/10/14, 1/7/14 Page 2 of 2