HomeMy WebLinkAboutWPO201900062 Application WPO VSMP 2019-10-28Virginia Erosion and Sediment Control Program (VESCP) 3 �'
Application for Albemarle County
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(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program, VSMP, and the DEQ General Permit)
Project Name: Southwood Redevelopment - Village 1
(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 ❑ No
County File Number:
(to be provided by the Countyfor new applications)
The following are required elements of new applications %fi-om 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 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
eonipliance with the approved plans and permits. -7
OgA1-00-00-001E0 Southwood Charlottesville LLC
Tax Map & Parcel Print Name of Owner Signature
09000-00-00-001AO Southwood Charlottesville LLC
Tax Map & Parcel Print Name of Owner Signature: of Owner
Tax Map & Parcel Print Name of Owner Signature of Owner
Tax Map & Parcel Print Name of Owner Signature of Owner
Contact Information for the Owner(s) to receive correspondence:
Print Name Dan Rosensweig
Address 919 West Main Street
City Charlottesville
Daytime Phone (434) 293-9066
State VA
E-mail drose nsweig@cviIlehabitat.o
16) 27/6
Date
D/Zj
Date
Date
Date
Zip 22903
7/l/14, Revised: 7/10/14, 1/71/15, 10/17/18 Page I oft
® B. All Fees [Code section 17-207]
Total acres proposed to be disturbed 12.86 Acres
Acres to be disturbed
Total Fee
Less than 1
$150 per review
More than 1
$300 per review
For amendments to an approved plan; $200 per review
Variances; $150 (per request)
Exceptions; $240
Mitigation Plan; $150
Construction Record Drawing; $300
® C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
® D. Mitigation Plan satisfying the requirements of code section 17-406 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 -bunts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all pdrns 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 Craig Kotarski
Address 608 Preston Ave., Suite 200
City Charlottesville
State VA Zip 22903
Daytime Phone (434) 327-1688 E-mail craig.kotarski@timmons.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 $ Date Paid By who? Receipt # Ck# By
7/1,114. Revised: 7/10/14, 1/7/15, 10/ 17/18 Page 2 of 2