HomeMy WebLinkAboutWPO202100059 Application 2022-02-07Virginia Stormwater Management Program (VSNIP)
Application for Albemarle Countv
Project Name.*
Crozet Self Storage
(Thy rtarne should be the sump as it appears on plans)
Is this an amendment,
modification, or transfer of an approved p
Is this a resubmission for rev*vie«�?
Yes El
No 9"'
I an? Yes ❑ N o 2"'
County File Number.* WP0- (to be provided by the C
owing for neu• vpp
I1cQtivlls%
Thefollowin,g are required elements of new UppI1Cutions [§1 7-401I For amendments uncI resubmissivns,
0
please indicate which items are being amended. Signatures irtust be pi0ovidedfor any submission.
Signahue of the Owner for each parcel
AN AGENT OR CONSULTANT)
(Required with eN•ery submission, NOT TO BE SIGNED BY
By signing this application :�s the o��•ner, I hereby certify
ith, and 1 have the authurit�t to :authorize the 1complied �i
property. 1 hereby grant the CountNv of Albeniarle
compliance with the approvt•ed plans and perinits.
05600-OO-OO-03200
Tax Map & Parcel
05600-OO-OO-032AO
Yousef LC
Print Name of Owner
Yousef LC
Tax Map & Parcel PI-ruit Name, of Owner
Tax Map &Parcel
Tax Map &Parcel
Print Naine ot'Owner
111*Hit Name of Owner
that all requirements of these plans and permits will be
and disturbing activities and development on the subiect
the right to enter upon the property as required to ensure
Contact Information for the Owner(s) to receive correspondence:
Print Namc:. Yousef LC
S i T , turc�ut'
trn a to fe
LOOO
xner
Signature of Owner
Signature of Ovv),rner
ate
Date
Date
address: 5717 Brownsville Rd
CityCharlottesville Brace:VA 22903
Daytime Plione: (�3 � �. p "7` " /gEmmafl,% �� M�-��j a� 42 1 i 1 f''a kill
r cn�iaYDcJ�X'T' Co� mC*%M..i