HomeMy WebLinkAboutWPO201900014 Application 2021-05-03Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: Football Farm
l71n name shuulJ be the same us it nppenrs on plate/
Is this an amendment to on approved plan? Yes id No ❑
Is this a revision or resubmission for review? Yes ❑ No la
County File Number: WPO201"W14
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The following are required elements of new applications [from code section 17-401]. For revisions or
amendments• please ini icale which items are being
submission. amended Signatures must he pravided for arW
la A. Signature of the O_ner 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, 1 hereby certify that all requirements of these plans and permits will be
romp6ed with, and 1 have the authority to aathorize 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
aromplisnce with the approved plans and permits
1'�l)e.de(
Si goattae °f O`s'neT Date
Tax Map & Patecl prim Name of Omtc Sigrmhue of Oww
Dane
Tax Map &parcel print Name of Owner Signature of Owner Dats
Tax Map & Parcel Prim Name of Owner Sigmatme of Owner
Date
Contact Information for the Owners) to receive correspondence;
Prim Name Tobias & Lynn Dengel
Address 540 Park St
City Cflarbttesville State VA
Zip 22902
Daytime Phone (-203) 439-1944 E-mail TobiasDengelOgmail.00m
Revised 0724/18 Page 1 of 2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 2.71
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
$7-700
$1.350
$200
5 and less than 10
$3,400
$1,700
S250
10 and less than 50
S4,500
$2,250
$300
50 and less than
too
$6,100
$3,050
$450
100 and more
S9,600
S4,800
S700
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.
10 E. Stormwater Management Plan satisfying the requirements of code section 17403.
El 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.
O H. Mitigation Plan satisfying the requirements of code section 17406 for any proposed disturbance of
stream buffers.
01. 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. Prafessional.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 Clark Gathright
Address 100 1Oth St NE Suite 200
City Charloteesville State VA Zlp 22902
Daytime Phone (434) 987-0294 E-mail cgathright@dgarchs.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 N
Fm Amount SiIAm Paid
0y who?
Receipt N
CkN By:
Revised 07/24/18 Page 2 of