HomeMy WebLinkAboutWPO201500044 Preconstruction Form •
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Request for Pre-construction Meeting and Grading Permit 4riVii**7.„„
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from Albemarle County g/
Approved Plan Number: WPO- fi 0 C) L l
Approved Plan Name: L-U T f f t 6 uvl oLore.„, - 1-4) c F 2
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: /0/OS /ic
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: $ mid
State Certification Number: 3 s-6 q O
Address ?,0_ gcy / gg
City ,�A le$u i[le State 0# Zip ZZ5 Z V
Daytime Phone 11 31 5-3( — /`f / i E-mail e.eR( a r t e a 0(, 60,44
Primary Contractor:
Print Name V if nO(eA EXCav�'�jDl�
Address C. 5CX ) 83
City a 'S u;I e State (/4 Zip Z Z g 2 y
Daytime Phone(y3y) S`3 / - I`//7 E-mail 1 e•ea(' GL f'( a01, eon&
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
1 and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised: 8/29/14 Page 1 of 3
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Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
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The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/1/14, Revised: 8/29/14 Page 2 of3