HomeMy WebLinkAboutWPO202000017 Application 2021-03-30M uryi
Virginia Stormwater Management Program (VSMP) �
Application for Albemarle County r
Project Name: ProfFt Road Townhomes South
fTlre name should be the sane as it appears on plum)
Is this an amendment to an approved plan? Yes ❑ No 121
Is this a revision or resubmission for review? Yes 0 NoQ
County File Number: W PO 2.020 00017(to be provided br the Coun{pfor aerouppbcannns)
The following are required elements of nets Wli('alions (from code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures niltst he provided for am
submission.
R 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 Mill be
complied with, and I have the authority to authorize the land disturbing activities and development on the subject
property. 1 hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits. r1 . A
Map &Parcel Print Name of Owner lignature of Owner Date
Tax Map & Parcel Print Name of Owner Signatuic of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of 0wner Signature of Owner Date
City 5� -Gi9 State UAZip cl
Daytime Phone (L��q �t/O J `f E-mail ��� ��'1 i�Qi).`� CY'2-/YtFj}s%t*�. Con
Revised 07.24 18 Paee t of 2
0 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 3.34,
Acres to be
disturbed
Total Fec
'cc Due with this
Fee with Trawler or
Less than
$290
Application
modification of permit
S145
$,p
I and less than 5
S2,700
S 1.350
S200
5 and less than i o
S3.400
S 1300
S_50
10 and less than 50
S4,500
$2,250
S300
50 and less than
$6,100
S3pill
S450
too
100 and more
S9.600
S4,800
S700
For (minor) amendments to an approved plan; S200 per review
Variances: $ ISO
Mitigation Plan; S150
0 C. Registration Statement on the official DEQ form.
0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
0 E. Stormwater Management Plan satisfying the requirements Of code section 17-403.
0 F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
2 G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17405.
❑ 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 17407 and 408.
❑ 1 Construction Record Drawings (as-builts) f'or any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 conies ofall mans and ani: supporting documents. Professional seals must have original
vignalures.
Additional in%rmation J not provided on plans and documents:
\$me of a Contact Person for correspondence (usually the plan prepater, consultant of agent)
Print 4ameJustin Shimp
Address 912 E. High St.
City Charlottesville State VA Zhp 22902
Daytime Phone (434 ) 227-5140 L-mail Justin@shlmp-engmeering.com
"When applications and plans are reviewed, but not approved, and a resptinse to comments is not received within 6 months
from the date of county comments, the application %ill he deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FIIa OFFICE GtiE OnI.\- wPOk
Fin Amuumi Date Paid Ity hrhu?_ _Rcceiptk CIA ae;
Revised 07 23118 Page 2 of 2