HomeMy WebLinkAboutWPO202100004 Application 2021-01-25Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
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Project Name: Southwood Phase 1 Blocks 9, 10, & 11
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 91
Is this a revision or resubmission for review? Yes ❑ No Ell
County File Number: (to be provided by the Countyfor 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. _ % , / , r,
09000-00-00-001AO Southwood Charlottesville LLC
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Tax Map & Parcel Print Name of Owner
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09OA1 00-00-001E0 Southwood Charlottesville LLC
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Tax Map & Parcel Print Name of Owner
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01/25/21
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
Address 967 2nd St SE
City Charlottesville
Daytime Phone (571) 282.1615
avinisky@cvillehabitat.org
VA Tin 22902
Revised 07/24/18 Page 1 of
❑ B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 797
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.
® 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 17-404.
® 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 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 Bryan Cichocki
Address 608 Preston Ave, Suite 200
City Charlottesville
Daytime Phone (434) 327-5380
VA
E-mail Bryan.Cichocki@Timmons.com
22903
*When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 mouths
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 #
Fee Amowt $ Date Paid
By who?
Receipt #
Ck# By:
Revised 07/24/18 Page 2 of