HomeMy WebLinkAboutWPO202000027 Preconstruction Form 2020-12-10Request for Pre -construction Meeting and Grading
Permit from Albemarle County -VSMP
Approved Plan Number:
Approved Plan Name:
(Plans must be approved prior to a pre -construction meeting.)
(Bonds must be approved and posted prior to a pre -construction meeting or permit)
Responsible Land Disturber:
Print Name:
State Certification Number:
Address / O Zip , /07 O
City L-Cl U t Sc--,- State VP�_ Zip
Daytime Phone
Primary Contractor:
Print Name
Address 1() U-// / Ih J /
City L�h�✓'/� f>�CS✓I State
Daytime Phone ( b)�_ 830-7
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Permit Issuance and First Year Maintenance Fees (Request must include payment):
Total acres proposed to be disturbed is contained on the approved plan and
annlication: VSMP:
Acres to be disturbed
Fee Due at Grading Permit
Less than l
$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
•m
V6 Zip 2z562.
Annual Maintenance Fees [Section 17-208 of the Albemarle County Code] - Annual maintenance fees will be assessed
in March of every year this permit is active. Fees cannot be prorated after the first year of permit issuance.
7/l/14, Revised: 8P29114. 8128/19. W5F2020 Pape 1 of 3
Person(s) to attend the Pre -construction Meeting:
FOR OFFICE USE ONLY
VVFO
Fee Amount S Date Paid By who? Receipt # Ck# By!
7/1/14. Revised: 829/14.828/19.8252020 Pa¢e2 of 3
Centralized Payments
O Your Payment Was Submitted
Transaction ID:
Transaction Time:
Total Paid:
5MS54547B7981371L
12/10/2020 11:54 AM
$609.54
We will receive notification of your online payment at the time that it is made and we will
credit your payment as of that day. However, you will not see the payment on your
account for approximately 48-72 hours due to the time that it takes to get those funds
into our bank account.
a3 Cancel Payment (http://www.albemartecountytaxes.org/default.aspx?pagelD=1108mp=Master.Master)
httpsJAv.albemarlecountylaxes.org/default.aspx?pagelD=1108mp=Master. Master&token=EC-3DG809003G599633R&PayerlD=KFJEE4JKLy40C 1/1