HomeMy WebLinkAboutWPO201300002 Application 2020-05-046 nth
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: NORTHTOWN PHASE I
(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-2013-0002 (lobe provided by the Counlyfor 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 Prooerw 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.
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name FIRST GOLD LEAF LANQ TRUST
Address PO BOX 5549
City CHARLOTTESVILLE State VA Zip 22905
Daytime Phone (4a41375-3334 E-mail ulcwww0embargmailcom
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IN B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed
res to be
sturbed
Total Fee
Fee Due with [his
A lication
Fee with Transferor
moth icatiMsf ermit
ss than 1
$290
$145
$20
and less than5
$2,700
$1,350
$200
nd less than 10
[50
$3,400
$1,700
$250
and less than 50
$4,500
$2,250
$300
and less than 100
$6,100
$3,0500
and more
$97600
$4,800
$700
For (minor) amendments to an approved pl 00 per revie
Variances; $150 (per request)
Mitigation Plan; $150
❑ C. Registration Statement on the official DEQ form.
® D. Erosion and Sediment Control Plan satisfying the requirements of code section 17.402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403,
91 F. Pollution Prevention Plan satisfying the requirements of code section 17404.
IN G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all Plans and arry supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and docranents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name SCOTT COI I INS- COI I IPJS ENGINEERING
Address 200 GARRETT STREET SURE
City CHARLOTTESVILLE State VA Zip 22902
Daytime Phone (434)293-3719 E-mail s[ott[)Collins_enging�gcom
"When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 month,
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY
W o a
Fee Amount$ Date Paid
Byw 9
Receiptk
Ckq
By
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