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Home My WebLink AboutWPO202000006 Application 2020-10-29Albemarle Countv Planning Application 431 "-',tire Sand Cns"D!`esv,.,e : (434; 2_06-5S32 Fax: LLC Application* Legal Description I ACREAGE SPROUSE'S USED FURN Magisterial Dist. Samuel Miller v Land use Primary Residential -- Singlc-family (incl. modular homes Current RFD Not In A/F District ,v f Current Zoning Primary Rural Areas *. Street Address I201 2946 MONACAN TRAIL RD NORTH GARDEN, 22959 Application Type Water Protection Ordinances Project I Polly s Folly - VSMP Received Data 02/10/20 Received Date Final, Submittal Date Closing File Date Submittal Date Final Revision Number Comments I_ Legal Ad Entered By Jennifer Pntcl . 1211;'�020 Total Fees Total Raid SUB APPLICATION(s) Type Sub Apiplicatio Crnt•,rrwett Stormwater Management/BMP Plan Erosion and Sediment Control Platt l 02/10/20 € 02/10/20 _ _ APPLICANT / CONTACT INFORMATION Car tactType_ - P18rr _I address _ Ci State Zip__ Phm e � e 41 ']+.-n�C:4%•a-t :THPEEDEELLC fe.... .. Tom.. .. Pr ay _c_..ex CLARK OATHRIOHT C i : 1429 BURCHS CREEK P.DRD 100 IRfH ST NE. STE leg -a �_ CHAN oTTESVILL 'jj903 4348231970' ; 4345870294 � 3 CHARLOTTESULL 22902 34 8. W. 4 • • .._ ' Signature of Contractoror Authorized Agent .Date a vim. Virginia Stormwater Management Program (VSMP) .1 Application for Albemarle County 1l1�:1�1� Project Name: Polly'sFolly (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No Is this a revision or resubmission for review? Yes ❑ No H County File Number: be provided by the Countvfor 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. ❑ 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. 0870MO-00-02600 ThreeDee LLC Tax Map & Parcel Tax Map & Parcel Tax Map & Parcel Print Name of Owner Print Name of Owner Print Name of Owner 1.14.20 of Owner Date of Owner Date Signature of Owner Tax Map & Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owner(s) to receive correspondence: Print Name Polly Davis Address 1429 Burchs Creek Road Charlottesville Daytime Phone( 43 ) 823.1970 Ismail dayisdoig@gmail.com VA 7;,, 22903 Revised 07/34/18 Page I of 2 0 B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed Less than 1 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; $150 ❑ C. Registration Statement on the official DEQ form. 1L7 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 14] E. Stormwater Management Plan satisfying the requirements of code section 17-403. �V F. Pollution Prevention Plan satisfying the requirements of code section 17-404. `6r7 G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies ofall plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent) Print Name(Z`Ark y°IIAWI4q 3 Address1,VJ0 �OF� S\ NE,,�� City �ho r� a� t'SV ll�t State r zip Z,2.R0z Daytime Phone (131-) 9�7— 02 g } _ E-mail C.i -,�NYI LA 4V"c�, J *When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 months from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY wP0 #� '�)) Fee Amoun[$_t✓r��•C Date Paid By whoiJ ° Receipt# c.Ls y:,�P Revised 07/24l18 Page 2 of 2 COUNTY OF ALBEMARU Department of Community Developmem 401 MdWmRoad Charlottesville, VHjW8 22902 VSW Application Completeness Check Project Title?C? File Number: 1 Date: ° WZP6 2-0 Reviewere32 c Your application has been checked for completeness per section 17-409 of the County Code, All items must be received and correct for the application to be deemed complete. ❑ This application is complete and plan review has begun ❑ This application is not complete. Please provide the missing items checked below. Received Y N 9 ❑ Completed application sl ❑ Signatures of the Ewffly Owners for each parcel affected ❑ Correct Fees Paid ❑ J6, Registration Statement on the official DEQ form, with correct LDA ❑ Erosion and, Sediment Control Plan satisfying the requirements of code section 17-402. Or. ❑ Stormwater Management Plan satisfying the requirements of code section 17-403. id ❑ Pollution Prevention Plan satisfying the requirements of code section 17-404. The EPA template should be used. ❑ Stormwater Pollution Prevention I'lan satisfying the -requirements of code section 17-405. The EPA template should be used. ❑ Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ Requested Variations or Exceptions as provided in code sections 17-407 and 408, if applicable. (SSF, MMT, etc) ❑ , 91, Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17422. Comments: F V s 00-54 �(7 die) 2-yam 0�4 - 3rd) 10 Correct Y N N/A ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑