HomeMy WebLinkAboutWPO202100032 Application 2021-05-20Virginia Erosion and Sediment Control Program (VESCP)
Application for Albemarle County
�IACAN�P
(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program, VSMP, and the DEQ General Permit)
Project Name: Woodlands Road - Perez
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 0
Is this a revision or resubmission for review? Yes ❑ No 10
County File Number: (to be provided by the Countyfor new applications)
The following are required elements of new applications Lfi-on; code section 17-4011. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
® 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. _
44-23B Manuel Perez
Tax Map & Parcel Print Name of Owner Signature of Owner
Tax Map & Parcel Print Name of Owner Signature of Owner
Date
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 Manuel Perez
Address 2358 Proffitt Road
City Charlottesville
State VA Zip 22911
Daytime Phone (434) 465-8472 E-mail southborderconstruction
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® B. All Fees [Code section 17-207]
Total acres proposed to be disturbed 1.75
Acres to be disturbed
Total Fee
Less than 1
$150 per review
More than 1
$300 per review
$300
For amendments to an approved plan, $200 per review
Variances, $150 (per request)
Exceptions, $240
Mitigation Plan; $150
Construction Record Drawing, $300
® C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
0 D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ E. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ F. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies oiall 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 Alan Franklin, PE
Address 427 Cranberry Lane
City Crozet
State VA Zip 22932
Daytime Phone (434) 531-5544 E-mail alan@alanfranklinpe.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 Amowt $ Date Paid
By who?
Receipt #
Ck# By:
7/1/14, Revised: 7/10/14, 1/7/15, 10/17/18 Page 2 of2