Loading...
HomeMy WebLinkAboutWPO202100013 Preconstruction Form 2021-08-30Request for Pre -construction Meeting and Grading Permit A`'a from Albemarle County — VSMP k .�, �Yq,n�lA�. Approved Plan Number: WPO- 2a Z� o&c,13 DEQ Permit # (if applicable): VAR10- Approved Plan Name: jArmcn c C(fn 1 U I �oVtw-N T P"t P - '}' - Ot 1 U "' lyi P (Plans must be approved prior to a pre -construction meeting.) Bond approved date: (Bonds must be approved and posted prior to a pre -construction meeting or permit.) Responsible Land Disturber: Print Name: State RLD Number. Address: LA55 4 , ,, \ i— 5E Sc,-r }4_� : ©1 city: [ V1 f I. 11E State: Q 4 zip: ZZ9 02 Daytime Phone: (LI!,) .5? k, - r),'-I S � E-mail: K en COc} ( %3c, „ c c n Primary Contractor: Print Name: N`av k i �„ F c i n -� i ka f [ u s �r crro-� L L L Address: 19:13 - 7 6 61I;,-A -_ } City: OyI`o t\tti,"�kz State: i)rV zip: 2Z4o3 Daytime Phone: H 9431 - tf q a?, E-mail: Q C.A c o r-i C� Permit Issuance Fees (Request must include payment) [Code §17-708]: Total acres proposed to be disturbed as shown on the approved plan and application: 5. /C Acres Acres to be Disturbed Total Fee Due for Grading Permit Total Fee = (Application Fee + 40% Technology Surcharge) Less than 1 $74.88 $72 + $2.88 Single -Family Dwelling only - $74,88 less than 5 ($72 + $2.89) 1 and less than 5 acres $700.96 $674 + $26.96 5 and less than 10 acres $881.92 $848 + $33.92 10 and less than 50 acres $1,167.92 $1,123 + $44.92 50 and less than 100 acres $1,581.84 $1 521 + $60.84 100 acres and more $2,490.80 ($2,395 + $95.90) Annual maintenance fees are assessed in arrears on April 1 each year or portion of a year that this permit is active [Code § 17-208]. 7/1114 Rrviged•RMQ/ld 10/1R/1R 7/1/7071 706/7071 Pnual nfi Person(s) attending the Pre -construction Meeting: The second part of the application fee is required to be paid with this request. This fee amount is: FOR OFFICE USE ONLY Permit Issued Date By who? OW -A (.Zro 7/1 /14 Revised• R/79/14 1 n/l R/1 R 7/1 Mn71 7/76/7071 Pave 7 nf'i