HomeMy WebLinkAboutWPO202100005 Other 2021-05-13Internal Use Only
Date Received: Fee Paid: OF AL$p,
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Intake: Forward to Management Analyst ,
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REQUEST TO ESTABLISH A BOND
APPROVED PLAN # WPO-2021-00005
PROJECT NAME: Alterations to the Ivy Material Utilization Center Irrigation Pond Dam
(As listed on the approved plan)
All parcels in the project, including any off -site work if easements are not provided, and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must be correct, and plans must be
approved prior to bond estimates being prepared.
TAX MAPS / PARCELs: 73-28 OWNER'S Rivanna Soo Waste Authority
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SIGNATURE: n t P , date:
TAX MAPS / PARCELs: OWNER'S NAME:
TAX MAPs / PARCELs:
TAX MAPs / PARCELs:
TAX MAPS / PARCELs:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME
date:
date:
SIGNATURE: date:
NOTE: If ownership of the property is in the name of any type of legal entity or organization
including, but not limited to the name of corporation, partnership, limited liability company,
trust, association, etc., documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so,
The requested estimates are;
❑ VESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; $0 fee
W VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208; $250 fee required
❑ Subdivision (roads, drainage, etc.) per Subdivision Ordinance section 14-435;
& Water & Sewer per Subdivision Ordinance section 14-435; $269 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
EMAIL: pmckalips@rivanna.org
OR REGULAR MAIL ADDRESS: 695 Moores Creek Lane, Charlottesville, VA 22902
Revised 6202014, 11/32015