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HomeMy WebLinkAboutWPO202000003 Application 2020-04-28Virginia Stormwater Management Program (VSMP) A Application for Albemarle County 4'�ty`T Project Name: 2511 AVINITY DRIVE (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: WPO 2020-00003 (to be provided by the Countyfor netiv applications) The following are required elements of new applications Lf om code section 17-401 J. 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 1 have the authority to authorize the land disturbing activitiesFad development on the subject property. I hereby grant the County of Albemarle the right to enlf� upon the proy as required to ensure compliance with the approved plans and permits. / .4 t4 90-35 James s Moss Tax Map & Parcel Print Name of Owner Tax Map & Parcel Print Name of Owner Tax Map & Parcel Print Name of Owner Signature of Owner Signature of Owner �•3- 19 Date Date Date Tax Map & Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owner(s) to receive correspondence: Print Name James Moss Address 1799 Avon Street City Charlottesville State VA Zip 22902 Daytime Phone 4633 E-mail jasvlt Y m n4575 t M n+na.( . C a m Revised 07/24/18 Page 1 of 2 0 B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1.12 Acres to be disturbed Total Fee Fee Due with this Application Fee with Transfer or modification of permit Less than 1 $290 $145 $20 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 $4,500 $2,250 $300 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; $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. 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. ❑ I. 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 Daytime Phone (434) 299-9843 State VA Zip 22902 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 $ Date Paid By who? Receipt # Ck# By: 7/1/14, Revised: 7/10/14, 1/7/14 Page 2 of 2