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Home My WebLink AboutWPO202000054 Application 2020-11-24 r^=-`'- y,. Community Development Department Albemarle Cot y 4 IntireRoadCharlottesville.VA22902-4596 I` =11 '"I ,oice:(434)296-5832 Fax:(434)972-4126 ` + � Planning Application PARCEL/ OWNER INFORMATION IMP 07800-00-00-02300 Ot^;ner(s): THOMAS JEFFERSON MEMORIAL FOUNDATIO Application# WP0202000054 PROPERTY INFORMATION Legal Description l ACREAGE .-, Magisterial Dist. Scottsville � Land Use Primar,Semi-public v _ .- Current AFD Not in A/F District tv t Current Zoning Primary Monticello Historic District , APPLICATION INFORMATION I Street Address 11080 THOMAS JEFFERSON PKWY CHARLOTTESVILLE, 22902 Entered 6, Jennifer Smith 4pplication Tvpe Water Protection Ordinances I 11l25i2020 Project MONTICELLO ENSLAVED BURIAL GROUND - VSMP - DIGITAL Received Date 11/24/20 Received Date Final I j Submittal Date Total Fees i 0.0000 Closing File Date Submittal Date Final Total Paid 290 Revision Number Comments r---- Legal Ad SUB APPLICATION(s) APPLICATION(s) Type SLb Applicatio I Comment Erosion and Sediment Control Plan 11/24/20s Stormwater Management/BMP Plan 11/24/20 APPLICANT / CONTACT INFORMATION ContactT Name Address ,- Zi• Phone PhoneCell ow Primary Contact BRYAN CICHOCKI,PE 608 PRESTON AVE,SUITE 200 CHARLOTTESVILL 22903 4343275380 Applicant GARDINER HALLOCK P.O.BOX 316 i CHARLOTTESVILL 22902 4349847573 I Cate Signature of Contractor or Authorized Agent 11F ALj Virginia Stormwater Management Program (VSMP) z' Application for Albemarle County Project Name: Monticello Enslaved Burial Ground (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No (a Is this a revision or resubmission for review? Yes ❑ No V County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011 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. (� 07800-00-00-002300Thomas Jefferson Foundation 1 11 /20/2020 Tax Map&Parcel Print Name of Owner Signature of Ov\ner Date 07800-00-00-002200Thomas Jefferson Foundation �(�`— p �— 11 /20/2020 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: Print NameGardiner Hallock Address P.O. Box 316 CityCharlottesville StateVA Zip 22902 Daytime Phone(434 ) 984-7573 E-mail Ghallock@Monticello.org Revised 07/24/18 Page 1 of 2 ,/A C 1V m B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 0.76 Acres Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application 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 $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan; $150 ❑ C. Registration Statement on the official DEQ form. O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. m E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. O H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. O I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print NameBryan Cichocki, PE Address 608 Preston Ave. Suite 200 CityCharlottesville StateVA Zip 22903 Daytime Phone(434 ) 327-5380 E-mail Bryan.Cichocki@Timmons.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. \\ FOR OFFICE USE ONLY WPO t# �I— I/� f Fee Amount$O 6 - Date Paid l who? Receipt#d`(,v1 l W iCk# c CBy u : OI o5aa Revised 07/24/18 Page 2 of 2