HomeMy WebLinkAboutWPO201400064 Application Erosion Control Plan 2020-03-20Virginia Erosion and Sediment Control Program (VESCP) �' r
Application for Albemarle County
(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program, VSMP, and the DEQ General Permit)
Project Name: Hyland Ridge
(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: WP02014-00064
(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 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. f
78-57 Charles W. Hurt
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
Tax Map & Parcel Print Name of Owner Signature of Owner
Contact Information for the Owner(s) to receive correspondence:
Print Name Dr. Charles W. Hurt
Address 195 Riverbend Dr.
City Charlottesville
Daytime Phone 4( 34) 979-8181
Date
Date
Date
Date
State VA Zip 22911
E-mail Charlie@VirginiaLandCompany,com
7/1/14, Revised: 7/10/14, 1/7/15, 10/17/18 Page 1 of
&4 . All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed
0.4 O Ar_r.
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
S290
S 145
S20
1 and less than 5
S2,700
S 1,350
S200
5 and less than 10
S3,400
S1,700
S250
10 and less than 50
S4,500
S2,250
S300
50 and less than
100
S6,100
S3,050
S450
100 and more
S9,600
S4,800
S700
For (minor) amendments to an approved plan; S200 per review
Variant es; . Z.
Mitigation Plan; S 150
w IS C. Registration Statement on the official DEQ form.
IJk� D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
HrE. Stormwater Management Plan satisfying the requirements of code section 17-403.
tfb� F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
►M-G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
ldP H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
►4 I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
N® 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 / ks�j f, G C-C t-1t
Address _ 111 Sa --\� V4% S g r-,
City t._4f nt state 0 Zip 1.,2- ( 1
Daytime Phone [ �I]t) �I �1 - �Z OS _ E-mail +r+. +/1 9, t-" 4.� . ea
*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" Receipt # Ck# Bv-
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