HomeMy WebLinkAboutWPO202000042 Application 2020-09-08� nis M
Virginia Erosion and Sediment Control Program (VESCP)
Application for Albemarle County
(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program, VSMP, and the DEQ General Permit)
Project Name: 2435 Gobblers Ridge Pond
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 8
Is this a revision or resubmission for review? Yes ❑ No 8
County File Number:
(to be provided by the County for 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.
R 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 right to enter upon the property as required to ensure
compliance with the approved plans and permits.
TMP 93-15 Calvin Danbe
Map & Parcel Print Name of Owner
8-2(e-
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:
Prim Name Calvin
Address 2435 Gobblers Ridge Rd
City Charlottesville
Daytime Phone (AM) 996-5458 E-mail dabneycwCaol.com
State VA Zip 22902
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