HomeMy WebLinkAboutWPO202000028 Application 2021-12-02Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
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Project Name: Regents School of Charlottesville
(The name .should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 10
Is this a revision or resubmission for review? Yes 91 No ❑
County File Number: UP0 2020 -000 AV (to be provided by the CountyJbr new applications)
The following are required elements of new applications ffrorn code section 17-401 J. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
10 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, f 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 rigllt-to enter upon the property as required to ensure
compliance with the approved plans and permits. / 7 ) n
Tax Map & Parcel Print Name of Owner vc' Sigt(atuWo(?5r Dale
76-17
Tax Map & Parcel Print Name of Owner Sidnatur4 of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Informafigtt for the Owner(s) to
Print
Address
Revised 07/74/IR Pnvr I nf7
❑ B. All Fees [Code section 17-2081
For new or modified plans; Total acres proposed to be disturbed 9.76 IRS-,
Acres to be
Total Fee
Fee Due with this
Fee with Transferor
disturbed
Application
modification of permit
Less than I
S290
S145
$20
1 and less than 5
S2,700
$1,350
$200
5 and less than to
$3,400
$1,700
S250
10 and less than 50
$4,500
$2,250
S300
50 and less than
$6,100
S3,050
S450
too
100and more
$9.600
$4,800
$700
For (minor) amendments to an approved plan; S200 per review
Variances; $150
Mitigation Plan; $150
0 C. Registration Statement on the official DEQ form.
0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
0 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
9 F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
0 G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ T. 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 ofcode section 17-422.
Provide 2 copies olall 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 Justin
Address 912 E. High St.
City Charlottesville $tatcVA Zip 22902
Daytime Phone 4( 34) 227-5140 E-mail jus6n@shimp-engineering.eom
*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 N
Fee Amount S_.— Dale Paid
Hy who?
aeceipta
Cka RY
Revierel n704/IR Poor 2 of 7