HomeMy WebLinkAboutWPO201800025 Bond 2019-01-15 • .Jnternar Use Only — 1/ /`cif l
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Date Received: Fee Paid:
Received In: r—''
Intake: Forward to Management Analyst an
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REQUEST TO ESTABLISH A BOND
APPROVED PLAN #WP0201800025
PROJECT NAME: Crozet Water Treatment Plant Expansion and Rehabilitation Project
(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: 57-29B OWNER'S N . - iva ,r&Sewer Authori
SIGNATURE: date: / 1'551/9
TAX MAPs/PARCELs: 57-10A OWNER'S ter&Sewer Authority
SIGNATURE: date: / M
TAX MAPs/PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAPs/ PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAPs/PARCELs: OWNER'S NAME:
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 he 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;SO fee
Ga VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208;S250 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: sschiller a rivanna.org
OR REGULAR MAIL ADDR1L.
Revised 6/20/2014,11/32015
l\,h,6I1NA
695 MOORES CREEK LANE
CHARLOTTESVILLE, VA 22902-9016
TEL:434.977.2970
FAX:434.293.8858
WATER&SEWER AUTHORITY WWW.RIVANNA.ORG
TRANSMITTAL
TO: Ana D. Kilmer DATE: January 15, 2019
Community Development Department
County of Albemarle
401 McIntire Drive
Charlottesville, VA 22902
SUBJECT: Request to Establish a Bond -WPO201800025 - Crozet WTP Expansion
and Rehabilitation Project
The following items are being sent: 0 Attached 0 Via Fax
❑ Copy of Letter 0 Specifications 0 Shop Drawings
❑ Plans 0 Contract 0 Other
❑ Plat 0 Change Order
Copies Description
1 Request to Establish a Bond for WPO201800025
❑ For Your Signature
❑ For Approval
❑ Approved as Submitted
❑ Resubmit Copies for Approval
❑ For Your Use
❑ Approved as Noted
❑ Submit Copies for Distribution
❑ As Requested
❑ Returned for Corrections
Remarks: Please initiate the process to establish a value for an E&S bond on the above-
refenced project and if you need anything else from me, please don't hesitate to ask.
Thanks.
Scott Schiller, P.E.
Engineering Manager
•
Fee Received
RECEIV
ED
Received Date
JAN 1 6 7nl4
/ ' g COMMUNITY
Received By DEVELOPMENT