HomeMy WebLinkAboutWPO202000017 Application 2020-03-23Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: froffit Road Townhome South
(The name should be the .game as it appears on plan)
Is
this
an amendment to an approved plan: Ves 0
No 9
Is
this
a revision or resubmission for review? Ves 0
No id
Coutity File Number., (to be provided by the Coun ty. for n applications)
Th e fio 11owing are required elements o 'new app 11 ca tions gro m code sectio n 1 , 4 0 ] . For revis ion s or
amendments, pleas e indicat wh ich items are being a ni e. re . i natures rn i is t be proi dedfior and,
Submission.
a A. Signature of the Owner for each parcel.(Required with every submission or revision, NOT TO BE
SIGNED BY AN AGENT T OR CONSULTANT)
By signing this application as the owner, I hereby certify that all requirements of these plans and permits will he
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 eater upon the property as required to ensure
eo mplia rice with the approved -plans and permits,, is A 11 All r I
Tax Map & Parcel Print Name of Owner
�r
mature of Owner
3oDt.-n(,
Date
Tax ap & Parcel Print Name of Owner Signature of Owncr Date
Tax Map & Parcel Print Warne of owner
Signature of Owner
Date
Tax Map & Parcel Print Larne of owner Signaturc of Owncr Date
Contact Information for the Owner(s) to receive correspondence:
P ri n t Na me 0�,tn Apt
Address
City
L
Daytime Phone
be +rE-mail
con
StateZip c !�
Revised 071124/18 Page l of
IZ B. All Fees [Code section 17- 0 ]
F o y- new or m od i fi e d p l at s , Tota.l ac re s Propos ed to be di stur be d 3.30
P C.
Acres to be Total Fee Fce Due Frith this
disturbed
Application
Less than 1 $ 90 14
1 and less than 5 5 700 SL350
5 [Lnd less than i ,400 $1,700
10 and less than 50 $4,500 R250
50 and Less than # 1 oo , 50
10
100 and rno re $9,600 $4,800
For minor amendments to an approved p1.an:, S 2 00 per revI'
Variances; t 0
Mitigation Plan; S 150
Fee with Transfer or
rnodifiation of permit
0
00
30
S450
S700
Registration Statement on the official DEQ form..
Erosion and Sediment Control Plan safisfying the requirements f code section
Stormwater Management Plan satisfying the requirements of codr, section 17-403.
Pollution prevention Plan satisfying the -requirement of node section 17-404.
0 G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements f code section 17-406 for an r
stream buffers,
,
proposed d disturbance of
❑ I+ Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ ,T. onstm Lion Record Drawings a-builts for any existing fa ] 11 ties in the roe o alsatisfying
p Pthe
requirements of code section 17-422.
Provide 2 copies o `alb i -Y and any su
signatures. pportingdocuments.rqsioal sal:v must have original
Additional In formation if t pro vided on plans and do c urn en ts.
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Marne Justin ShImp
Address 912 E. High St.
citvCharlottesville
Day -time Phone () 7- 140
SlateVA
Zip 22902
E-mail justina himp-engineering. corn
*When applications and plans are reviewed, but not approved, and a response to eomments is not received within 6 wonths
from the cute of cnun comments, the application will he deemed withdrawn. Applications without valid owner's
signatures will not he considered valid.
FOR OFFT F USE ONLY
Y
'WTO #
Fcc Amount S Date Paid ..By wh o ? _ _ Receipt # Ck# By
Revised 07/24/18 Page 2 of