HomeMy WebLinkAboutWPO202100004 Preconstruction Form 2021-11-12ffA
Request for Pre -construction Meeting and Grading Permit F
from Albemarle County — VSMP ;n
Approved Plan Number: WPO- ) ' t0VO DEQ Permit # (if applicable): VAR10-_ ( a
Approved Plan Name: J dv. ] l 1 MOCK `i to -tr
(Plans must be approved error to apre-construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to a pre -construction
Responsible Land Dis ber:
Print Name:
State RLl
Address:
11 \
City: �� C��� 1, 1 Staten Zip: gzgn-Z
Daytime Phone: (ram t -mail: L%J 111-9 5 SCi� W 4 G�� t �U -
/1 /1
Primary Contractor:
Print Name:
t^
Address:
City:
Daytime Phom
7j 4,
el._L�
Permit Issuance Fees (Request must include payment) [Code §17-708].
Total acres proposed to be disturbed as shown on the approved plan and application Acres
Total Fee Due for Grading Permit
Acres to be Disturbed
Total Fee = (Application Fee - 4% Technology Surcharge)
Less than 1
$74.88
$72 + $2.88
Single -Family Dwelling only -
$74.98
less than 5
($72 + $2.88)
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
$ I l23 + $44.92
50 and less than 100 acres
$1,581.84
$1,521 + $60.84
100 acres and more
$2,490.80
$2 395 + $95.80
Annual maintenance fees are assessed in arrears on April 1 each year or portion of a year that this permit is active
[Code $17-208].
7/l/14. Revised: 8/29/14. 10/18/18, 7/l/2021, 7/26/2021.9/15/2021 Page 1 of
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?
7/l/14. Revised: 8/29/14, 10/18/18. 7/l/2021. 7/26/2021. 9/15/2021 Nee 2 of