HomeMy WebLinkAboutWPO202000015 Application 2020-06-08. pti :itrys,f
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
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Project Nance: Perry Residence
(Tire name .should he the same cis it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 2
Is this a revision or resubmission for review? Yes (0 No ❑
County Pile Number: WP0202000015 (!o he provided h- the C'ounrajor new applicr7trons)
Tile, following are rerluired elvinents of new cippliculions [front code .section 174011. ror revisions car
L-nnendmenis, please lndicttle which !teals are behl q amended. Si117Caltares 11711,vt be provided for any
saabinissiota.
0 A, Signature of the Owner for each parcel. (Required With every submission or revision, NOT TO BE
SIGNER BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I hereby certify that all requirements of these plans anti 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 nud permits. 1~7
51-24C Robert
Tax Map S Parcel Print lame of Owner
Fax Map & Parcel Print Name of Owner
Tax ivlap &C Parcel Print Name of Owner
Date
Signature of owner Date
Signature of Owner Date
Tax Map K Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name Robert Pe
Address 38 Enclosure Dr_
City Morganville state NJ Zip 07751
Daytime Phone 1731�} /��S7,t C-mail l , avan
Revised 07/24118 Page 1 of2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed
3.58 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
l 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
Registration Statement on the official DEQ form.
Erosion and Sediment Control Plan satisfying the requirements of code section 17-402,
Stormwater Management Plan satisfying the requirements of code section 17-403.
Pollution Prevention Plan satisfying the requirements of code section 17-404.
V 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.
❑ 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 co ie.s of all plans and any supporting documents. Professional seats 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 NameJustin Shimp
Address 912 East High St.
City Charlottesville State VA Zip 22902
Daytime Phone (434) 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 R'PO #
Fee Amount $ Date Paid By who? Receipt 4 Ck# By:
Revised 07/24/ 18 Page 2 of 2