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Home My WebLink AboutWPO201900008 Application WPO VSMP 2019-02-14 l3 �fi' AlbemarleCon CommunityoDevelopment 22epartment „as 4£?1F, eRoaUCharlttesville.LA9fl2- 596 Voice. (434)296-5532 Fax:(434j 972-4126 \\!..: ,j Planning Application PARCELLOWNER INFORMATION IMP 08600-00-00-08000 Owner(s): CPCM TELFORD TRUST Application# WP0201900008 PROPERTY INFORMATION Legal Description BUNDORAN FARM Fl Magisterial Dist, Samuel Miller Land Use Primary Unassigned I'1 Current AFD ;Not in A/F District D Current Zoning Primary[Rural Areas [APPLICATION INFORMATION Street Address 901 CARPENTER DR NORTH GARDEN, 22959 Entered By r—� IJennifer PritcF1 Application Type Water Protection Ordinances tai 2,125/2019 Project Hendy Residence - VSMP Received Date 02/14/19 Received Date Final Submittal Date Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicatio Comment Stormwater Management/BMP Plan 02/14/19 Erosion and Sediment Control Plan 02/14/19 APPLICANT / CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhoneCell CPCM TELFORD TRUST 7993 LANGHORNE RD SCOTTSVILLEVA 24590 Pnnsry Conta_t JUSTIN SHIMP 912 E HIGH ST CHARLOTTESVILL 22902 4342275140 Signature of Contractor or Authorized Agent Date t . iof A(!kt Virginia Stormwater Management Program (VSMP) ; +�11`ty Avg, Application for Albemarle County 9. rop Project Name: -{na9 (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No f Is this a revision or resubmission for review? Yes ❑ No Kt County File Number: (to be provided by the County for 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. 0 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 Qlans and pernpjt . C Ch'L it1far� A (�1�" x \— gu GbAs4-act �-t ; ,-r(� �� alOy Tax Map&Parcel C Print Name of ON ' C� �{ Signature of Owned, azp /(ct, t ` Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner fine XContact Information for the Owner(s)to receive correspondence: (�,�C4 1 illy hex ,r i Thi-v?-e Print Name C� C Tfi oY �fnu1(�T �r`d ei 45 T'1.t v Address 6 M t 11 (t-0f City cCbb1/1 Y� _ State_ VA- Zip 2-4 5i 0 Daytime Phone�l�/) 7D 1 ti O E-mail C o 'boVCia 4_c y} vt,t t. CAM Revised 07/24/18 Page I of 2 ❑ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1 .75 Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 145 $20 1 and less than 5 $2,700 $1,350 —1 $200 5 and less than 10 $3,400 ,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 A C. Registration Statement on the official DEQ form. 7 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. E. Stormwater Management Plan satisfying the requirements of code section 17-403. LZ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. A G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name V L(Sfilr\.511. N1. Address I A. El }{1.9 f CityC LL . , State jc Zip 2,29tol, Daytime Phone M34) Al Sig 0 -E-mail jlik.Sri 1v(> — Q ,]h62AA 01( 1 *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who9 Receipt# Ck# By: Revised 07/24/18 Page 2 of 2 -ee Received RECEIVED Received Q,ate FEB 1 i. '" ' 2Ct(4 lt COMMUNITY Received By DEVELOPMENT