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REQUEST TO ESTABLISH A BOND
APPROVED PLAN # SDP2019-0062
PROJECT NAME: Georgetown Hydraulic Professional Offices
(As listed on the approved plan)
All parcels in the project, including any off -site work if easements are not provided, and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must be correct, and plans must be
approved prior to bond estimates being prepared.
TAX MAPS / PARCELs:
060F0-00-00-3COWNER'S N
draulic Georatown LLC
SIGNATURE:
date: 06/15/20
TAX MAPs / PARCELs:
OWNER'S NAME:
SIGNATURE:
date:
TAX MAPS / PARCELs:
OWNER'S NAME:
SIGNATURE:
date:
TAX MAPs / PARCELs:
OWNER'S NAME:
SIGNATURE:
date:
TAX MAPS / PARCELs:
OWNER'S NAME:
SIGNATURE:
date:
NOTE: If ownership of the property is in the name of any type of legal entity or organization
including, but not limited to the name of corporation, partnership, limited liability company,
trust, -association, etc., documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so.
The requested estimates are:
❑ VESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; SO fee
V VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208; S250 fee required
❑ Subdivision (roads, drainage, etc.) per Subdivision Ordinance section 14435;
& Water & Sewer per Subdivision Ordinance section 14-435: S269 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
EMAIL: robbyfa�tbmcom.com
OR REGULAR MAIL ADDRESS: C/o Building Management Company
400 Locust Ave, #3
Charlottesville, VA 22902
Revised 6202014. 11/3/2015