HomeMy WebLinkAboutWPO201900014 Application 2021-05-17Virginia Stormwater Management Program (VSMP) is
Application for Albemarle County
Project Name: Foothill Farm
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ® No ❑
Is this a revision or resubmission for review? Yes B No ❑
County File Number: WP02019-00014 (to be provided by the Counlyfor new applications)
The following are required elements of new applications [from code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
EA. 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, 1 hereby certify that all requirements of these plans and permits will be
complied with, and 1 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.
62-71 Tobias & Lynn Den
Tax Map & Parcel Print Name of Owner
Tax Map & 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 Tobias & Lynn Dengel
Address 1996 Foothill Farm Drive
City Charlottesville State VA Zip 22911
Daytime Phone (203) 439-1944 E-mail TobiasDengel@gmail.com
Revised 07/24/18 Page 1 of 2
0 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
Lessthan 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
100
$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
id C. Registration Statement on the official DEQ form.
® 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.
❑ 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.
❑ 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.
❑ 1 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. Professional 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 10th St NE Suite 200
City Charloteesville State VA Zip 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 #
Fee Amount $ Date Paid
By who?
Receipt #
Ck# By:
Revised 07/24/18 Page 2 of 2