HomeMy WebLinkAboutWPO201800031 Application 2020-05-18Virginia Stormwater Management Program (VSMP) aA
Application for Albemarle County
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Project Name: HOLLYMEAD TOWN CENTER HOTEL AMENDMENT
(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-2018-00031 (to be provided by the Countyfor new applications)
The following are required elements of new applications [from code section 17-4011. For revisions or
amendments, please indicate which items are being amended Signatures mast be provided for any
submission.
O 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, l 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.
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46-33HO
Tax Map & Parcel
Samuel
Print Name of Owner
47-1 C Samuel
Tax Map & Parcel Print Name of Owner
Tax Map & Parcel
Print Name of Owner
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Signature of Owner Date
10
s =ls_ z0
Signature of Own r Date
Signature of Owner Date
Tax Map &Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name SAMUEL F JR BYERS
Address 2856 LAUREL COVE ROAD
City CHARLOTTESVILLE
Daytime Phone
E-mail
_State VA Zip 22901
Revised OT24'18 Page 1 of
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 0.95 AC
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20 Y
I 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
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.
® F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
Q 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.
Cl 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ L Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 cQi2ies ol all Mans and any supporting documents. Professional seals mast 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 Namedustin Shim
Address 912 E High St.
City Charlottesville _ State VA Zip 22902
Daytime Phone (434) 227-5140 _ E-mail Justin@skimp-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 who9 Receipt # Ck# By:
Revised 07; 24 `1 S Page 2 of 2