HomeMy WebLinkAboutWPO202100048 Preconstruction Form 2021-11-04Request for Pre -construction Meeting and Grading Permit
from Albemarle County — VSMP
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Approved Plan Number: WPO 4A - _ DEQ Permit # (if applicable): VAR10-
Approved Plan Name:
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: y f z,:.t_
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name:—�«•.:e,y i. L.y,.-_�{�r
State RLD Number,. RL8 00_343
Address: _ 1yi
City: riiprlei al j(Al __State: VA I Zip:2291t
Daytime Phone: t �sy) 2 K��8�4 >rmail: kl �rC9 s j e ' 0 ,1gA
Primary Contractor:
Print Name: ICe �`lcal�'
Address: _tt12 t
City:
State: Ok _ _. _ _ Zip: 710{ t
Daytime Phone: (rf 3Y )24S - tj,:C_ E-mail: nArZ(Es, l..j„ Mw„T. , �y
Permit Issuance Fees (Request must include pent) [Code §17-708j.
Total acres proposed to be disturbed as shown on the approved plan and application: ` Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
Total Fee = (Application Fee+4%Technology Surcharge)
Less than 1
— $74.88
$72+$2.88)
Single -Family Dwelling ouly —
$74.88
less than 5
($72 + $2.88)
1 and less than 5 acres
$700.96
$674+$26.96,$991B2
5 and leas than 10 acres
$848 + $33.92)$1,167.92
10 and less than 50 acres
41,123 + $44.92)
50 and less than 100 acres
_
$1,591.94
$i,
100 acres and more$2$2490.80
_ ($2,395+S95T80)
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/l/2021, 7/26/2021, 9/15/2021 Page 1 of 3
Person(s) attending the Pre -construction Meeting:
Names
Firm Contact Number or email
The second part of the application fee is required to be paid with this request. This fee amount is:
FOR OFFICE USE ONLY T Permit Issued Date
By who?
7/1/14, Revised: 8/29/14,10/18/18, 7/l/2021, 7/26/2021, 9/15/2021 Page 2 of3