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HomeMy WebLinkAboutWPO202000028 Application WPO VSMP 2020-05-13C'qy :il.l, Virginia Stormwater Management Program (VSMP)!¢_�, Application for Albemarle County Iht�4^41� Project Name: Regents School of Charlottesville (The name .should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No 0 Is this a revision or resubmission for review? Yes ❑ No ❑ County File Number: (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. 10 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 rig enter ! pon the property as required to ensure compliance with the approved plans and permits. 1 A t 75-66 Tax Map & Parcel 76-17 Print Name of Owner Tax Map & Parcel Print Name of Owner Tax Map & Parcel Print Name of Owner Tax Map & P Contact Infori Print Name Address Print Name of Owner for the Owner(s) to iff of Date Date Signature of Owner Date Signature of Owner Date WIN Revi..,ed 0704/1 R PAaP. 1 of 2 11 B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed g.� Z ax, Acres to be disturbed Total Fee Fee Due with this Application Fce with Transfer or modification of permit Less than 1 $290 $145 S20 1 and less than 5 S2,700 $1,350 $200 5 and less Wan 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 10 C. Registration Statement on the official DEQ form. 10 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 10 E. Stormwater Management Plan satisfying the requirements of code section 17-403. © F. Pollution Prevention Plan satisfying the requirements of code section 17-404. 10 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. ❑ 1. 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 conies ofall 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 Justin Shim Address 912 E. High St. City Charlottesville State VA Zip 22902 Daytime phone 4( 34) 227-5140 E-mail justin@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 it Fec Amount $__ _ Date Paid _ By who? Receipt / Ckl1 By: Revi¢nrt n?174/1R P—P 2 nf7