HomeMy WebLinkAboutWPO202100001 Application 2021-01-08Virginia Stermwater Management Program (VSMP)
Application for Albemarle County 4. ,¢
Project Name: 999 Rio Road
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 19
Is this a revision or resubmission for review? Yes ❑ No
County File Number: (to be provided by the Cauntyfor new applications)
The following are required elements of new applications [from code section 17-401J. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
idA. 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.
61-154B Windmill Ventures
Tax Map & Parcel Print Name of Ownc
i!7
Date
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 Name Windmill Ventures LLC
Address 535 Foxdale Lane
Charlottesville
VA yin 22903
Daytime Phone Vh LO0 9 e1U y l E-mail �'t t^ k WIPt 1&-�b t?ifr `f Aar ! . COrA,,
Revised 07/2411 B Page 1 of 2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 2_14
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
S3,400
S1,70D
S250
10 and less than50
$4,500
S2,250
$300
50 and less than
100
S6,100
$3,050
$450
100 and more
$9,600 ji
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150
Mitigation Plan; $150
B C. Registration Statement on the official DEQ form.
® 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 17404.
❑ 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 conies 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 Name Stephanie Paul
Address 912 E
City Charlottesville State VA Zip 22902
Daytime Phone 4( 34) 2275140 E-mail sle ILie@shimp-en ineerin .corn
CCra) shop-ent.'Aartn\y.com
'When applications and plans are reviewed, but not approved, sail 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 M
Fee Amount S Da1c Paid
By who?
Receipt p
CY# By:
Revised 07/24/18 Page 2 of