HomeMy WebLinkAboutWPO202000040 Application 2020-08-21Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: True Heritage Tasting Room at Merrie Will Farm
(The name should be the same as it appears on ptam )
Is this an amendment to an approved pbtn? Yes ❑ No is
Is this a revision or resubmission for review? Yes ❑ No IZ
County File Number: do be provided by the G'ouniv fnr tuw aWit otinnN
The following are required elements of new applications (from code section 1 i-41)1l. For revisions or
amendments, please indir ate which items are being amended. Stunatuies must he provided for any
submAlion.
P A. Signature of the PM e�rt,Y 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 ow ner, 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 grate. the County of Albemarle the right two e7 pun the prgperiy�a�" t'�quhrd to ensure
compliance with the approved plans and permits. ' 11 1
Tax Map
LY /" �..i(l„ — V � ,J L/ 2 1 A Li
& Parcel Print Name of Property Owner Signattue of Owner ' Date
Tax Map &Parcel Print Name of Properly Owner Signature of Owner Date.
Tax Map & Parcel Print Name of Proparty Owner Signature of Owner Date
Contact information for the Owner(s) to receive correspondence:
Print
Address
City 1Ga-is\< -State Vi'; _—Zip 2194q
pit11
Daytime Phone (� ��°\ E-mail t. �� rr<w�� - f s.r� -,-
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® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 154
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 (per request)
Mitigation Plan; $150
® C. Registration Statement on the official DEQ form.
0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
® 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.
❑ I. 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 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 Alan Franklin, PE; Waterstreet Studio, LLC
418 East Main Street
City Charlottesville
State VA Zip 22902
Daytime Phone 4( 34) 295-8177 E-mail afranklin@waterstreetstudio.net
*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 wP0 #
Fee Amount $ I /�Date Paid N "y who? I / ""'fie M \ 1 1 dV_V RL.ipt # VYk_ACkt 05 By; JP
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