HomeMy WebLinkAboutWPO202100015 Preconstruction Form 2021-09-01Request for Pre -construction Meeting and Grading Permit
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from Albemarle County— VSMP �'t
Approved Plan Number: WPO- 2OZI O DO 15 DEQ Permit # (if applicable): VAR 10-
Approved Plan Name: F& r
(Plans must be approved prior to a
I
Bond approved date: %• 3o • 2(
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name: JCeK;AV%&
State RLD Number: 19 3 3 I
Address: 16 ;L S Co.,, k! C tta.6 C i gale
City: c6rIsNos V. tic State: V6 Zip: Z2 90/
Daytime Phone: (�ft 2g5- S 3 7 V E-mail: _ S K i A1%& r, 9) CC t/q, rr,,
Primary Contractor: Print Name: J L
4114
Address:
City:
Daytime Phone: C___)
def�� uorlC �or o.,t�t�
State:
E-mail:
Permit Issuance Fees (Request must include payment) [Code §17-708]:
Zip:
Total acres proposed to be disturbed as shown on the approved plan and application: 2. gY_ Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
Total Fce=(Application Fee+4%Technology Surcharge)
Less than I
S74,88
$72 + $2.88
Single -Family Dwelling only —
S74.88
less than 5
($72 + $2.88)
1 and less than 5 acres
S700.96
$674 + $26.96
5 and less than 10 acres
S881.92
$848 + $33.92
10 and less than 50 acres
S1,167.92
$] 123+$44.92
50 and less than 100 acres
$1,581.84
Sl 521 +S60.84
100 acres and more
$2,490.80
$2 395 + $95.80
Annual maintenance fees are assessed in arrears on April 1 each year or portion of a year that this permit is active
[Code § 17-2081.
7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021 Page 1 of 3
Person(s) attending the Pre -construction Meeting:
Names (type or print) Firm Contact Number or email
Sts4: Y d.. xaf*#.S e C c t[;qitrr S270
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'
7/1/14, Revised: 829/14, 10/18/18, 7/1/2021, 7/26/2021 Page 2 of3
9/1/2021
Centralized Payments
O Your Payment Was Submitted
Transaction ID:
Transaction Time:
Total Paid:
03S94743P9844802R
09/01/2021 03:42 PM
$719.24
We will receive notification of your online payment at the time that it is made and we will
credit your payment as of that day. However, you will not see the payment on your
account for approximately 48-72 hours due to the time that it takes to get those funds
into our bank account.
a3 Cancel Payment(http://www.albemarlecountytaxes.org/default.aspx?pagelD=110amp=Master Master)
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