HomeMy WebLinkAboutWPO201800077 Application 2021-06-02 (4)Virginia Erosion and Sediment Control Program (VESCP)
Application for Albemarle County .�,
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(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program, VSMP, and the DEQ General Permit)
Project Name: Old Trail Village - Block 32 - VSMP
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes 0 No ❑
Is this a revision or resubmission for review? Yes ❑ No la
County File Number: WP0201800077
(to be provided by the Countyfor new applications)
The following are required elements of new applications (from 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.
055EO-01-32-000AO March Mountain Properties, LLC
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 Dave Brockman
Address 1005 Heathcroft Circle Suite 100
City Crozet
State VA zip 22932
Daytime Phone (702) 985-9088 E-mail dave@oldtrailvillage.com
7/1/14, Revised: 7/10/14, IM15, 10/17/18 Page 1 of2
❑ B. All Fees [Code section 17-207]
Total acres proposed to be disturbed
Acres to be disturbed
Total Fee
Less than 1
$150 per review
More than 1
$300 per review
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 ofall 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
Address 435 Merchant Walk Sq., Suite 300-159
City Charlottesville
State VA Zip 22902
Daytime Phone (434) 977-0205 E-mail ageorge@roudabush.twm
*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