HomeMy WebLinkAboutWPO201900006 Preconstruction Form 2019-05-30 Request for Pre-construction Meeting and Grading Permit
from Albemarle County t*ktfi
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Approved Plan Number: WPO- o'Z r q - 0000 6
Approved Plan Name: 77e COde✓i4.n CS; Koo I /%j orr /9/r1ei11i►1.e^ 7
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: S/30/15
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: /� l
Print Name: /T l7 I.); /; I lard . l i C. 4£ 7 )
State Certification Number: /1 bi Q3
Address el J "-e-
City ( /'0 y State 01 Zip ga 17
Daytime Phone(431 ,0 6 - a/61".- E-mail dLI `'^' aid; r/4r'OC•Cam''^
Primary Contractor: /`
Print Name 4G ,6i I f r ( C ,
Address 0 9S— ineevt / L'-
City 1/r� c22 ?'/
Daytime Phone(4 / State Zip
l 7? 37,re) E-mail dj( ) c q c '[/ard. C OM
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
1 and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14 Reviced• R/99/14 Patrol ..£l
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Person(s)to attend the Pre-construction Meeting:
Namesam� (type or print)/ /'ri Firm Contact Number or email
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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: 8/29/14 Page 2 of 3
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Phone and email address will only appear if the certificate holder has granted permission to display this
information publicly.
Banton, Dale
Schuyler , VA
Certifications:
• Responsible Land Disturber (RLD) #RLD07936 - Expires 10/15/2020
Banton, Delton
Schuyler, VA
Certifications:
• Responsible Land Disturber (RLD) #RLD07934 - Expires 10/15/2020
Page: 1 »
For assistance with the Certification Accreditation Tracking System(CATS)please email certification@deq.virginia.gov
(mailto:certification@deq.virginia.gov)or telephone(804)698-4375.