HomeMy WebLinkAboutWPO202000033 Application WPO VSMP 2020-06-09Virginia Stormwater Management Program (VSMP) (to
Application for Albemarle County
Project Name: Malloy Ford
(The name should he the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No ZI
Is this a revision or resubmission for review? Yes ❑ No m
County File Number: (to he provided by the C'oun(),for new applications)
The follow ng are required elements Of new a1717llcatlons � rom code section 17-401 J. Por revision or
amendments, please indicate which items are being amendeel. Signatures must be provided Jbr 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 activities and development on the subject
property. I hereby grant the Comity of Albemarle the right to enter upon the property as required to ensure
compliance with the apprevd plM4l1d permits.
Al
01
Tax Map & Parcel Print Nan a of O vner Signature of Owner D to
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner 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 Malloy Properties III LLC
Address 2070 Seminole Trail
City Charlottesville
Daytime Phone ( ) l-mail gmalloy2@aol.eom
VA Tin 22901
Cl
Revised 07/24/18 Page I oft
® B. All Fees [Code section 17-208]
For new or modified plans; 'Total acres proposed to be disturbed 0.91
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
Mitigation Plan; $150
m C. Registration Statement on the official DEQ form.
® D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
to E. Stormwater Management Plan satisfying the requirements of code section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ 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 copies of all plans and any suphorling documenl.v. Professional seals mclsl ha o I -ifaat
signal uses.
Additional informalion i1 not provided on plane and documenl.v:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Kendra Patrick
Address 912 E. High Street
City Charlottesville State VA Zip 22902
Daytime Phone (434) 227-5140 E-mail kendra@shimp-engineering.com
*When applications and plans are reviewed, but not approved, and a response to comments is not received within G 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 W110 N
Fcc Amount $ Date Paul 13y Who?^ Receipt it Cktf 13y:
Revised 07/24/18 Page 2 of 2