HomeMy WebLinkAboutWPO202000032 Application 2021-02-05Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
is
Project Name: 1300 Richmond Road - Flow Automotive
(The nacre should be the some as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No M
Is this a revision or resubmission for review? Yes No F1
County File Number: WPO202000032 (to be provided by Conn p � Countyfor new applications)
The following are required elements of new applications f out code section 17-4011. For revisions or
amendments, please indicate which items are being amended. Signatures nntst be provided for any
submission.
0 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. 'In
78-6 lIDO -a ( d
Tax Map & Parcel Print Name
78-7 DOQ c.
Tax Map & Parcel Print Name
Tax Map & Parcel Print Name
Signature of Owner
Date
s -z 9-zd
Date
Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name 3 v b e> 4 T UbLs ,a S /
Address SOO C-� Sr` ST �• r{ 1fSOe�
City t.Ji K_S' o VL S 0. ce (.« //1State /J C / Zip Z % O
Daytime Phone (�(a a e(o - S 6v 24 E-mail b �o WLat a 2le o Ln011..�' c Z, a tM
Revised 07/24/18 Page 1 of
® B. All Fees [Code section 17-208] Ct
For new or modified plans; Total acres proposed to be disturbed 3 L A G
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
]00
$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
10 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.
m 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.
❑ 1. 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 satisfyingthe
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 doctmnents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Kendra Patrick
Address 912 E. High St.
City Charlottesville State VA Zip 22902
DaytimePhone(4341 227-5140 E-mail kendra@shimp-engineering.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 p
Fee Amount S Date Paid
By who?
Receipt N
Cktl Blc
Revised 07/24/18 Page 2 of 2