HomeMy WebLinkAboutWPO202100001 Application 2021-04-29Virginia Stormwater Management Program (VSMP) B
Application for Albemarle County ,
Project Name: 999 Rio Road
(The name should be the same as it appears air plans)
Is this an amendment to an approved plan? Yes ❑ No 19
Is this a revision or resubmission for review? Yes IT No Q
County !tile Number: WP0202100001 (to be provided by the Coun tyjor new applieah'ans)
The following are required elements of new applications [Prom code section 17-4011. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
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 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.
Tax Mop & 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
City Charlottesville t q StateVA Zin 22903
Daytime Pbonc ( LOt) B �� y ! E-mail 0-4 u' � WICI.' lt�
Revised 07/24/1 B Page I of 2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Lesstban 1
$290
S145
S20
1 and less than 5
52,700
$1 350
$200
5 and less than 10
S3,400
S1,70D
$250
10 and less than 50
$4.500
S2,250
S300
50 and less than
100
$6,100
$3,050
S450
t00 and more
$9,600 1
$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 17402.
® E. Stormwater Management Plan satisfying the requirements of code section 17-403.
59 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 17406 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 satisfying the
requirements of code section 17422.
Provide 1 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information ifnot 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 High Street
Charlottesville
VA Zip 22902
Daytime Phone 4( 34) 227-5140 Email stephanie@shimp-engineering.com
CC'
*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 N
Fce Amount 5-Date Paid
By who?
Receipt N
CkN By
Revised 07/24/18 Page 2 of 2