HomeMy WebLinkAboutWPO202100015 Preconstruction Form 2022-03-09Request for Pre -construction Meeting and Grading Permit
from Albemarle County— VSMP 4;-,ti
Approved flan Number: WPO-_!2 OZI Obo 15 DF.Q Permit 9 (if applicable): VAR 10-�
Approved Plan Name: arm6nel,,,., (n, (L.A 6vi� foµ{se )5e1e
r t my must be npproeed prior• to a pre -construction meeting
Bond approved date: %- 30. 2
18tinds tint be approved tntd povted prior to n rre-corrsh uctlan meeting or permit./
Responsible Land Disturber:
Print Name: 5! o +s
State RLD Number:
Address: 16 ;L !r COMA Lr.t G W6 C i rote
City: C 6, r ie lfe s u' It _ state: V rF _ zip: Z a 9a !
Daytime Phone: Ctit lLqS- 5 370 k-mail: $ K t'new k CC V4.ce rr�
Primary Contractor:
I'IintName: SaMt _ ft�p e{ota� 40r1G 1-OY O�arrclVe ..--
Address:
City:
Daytime Phone: (—)
li-mail:
State: zip:
Permit Issuance Pees (Rryrrest nntrr rrlcktcle payment' /Code y;I --,nsj: q5
Total acres proposed to be disturbed as shown on the approved plan and application: ni!K ,Acres
Acres to be Disturbed
Less than I
Total Fee Due for Cfadins Permit
'rulul Fee = (Application Fee +4% Technoloer Sur,
1 ts72 + $z Sal
FSand
-Family Divelling only- 574.88
an 5 ($72 i $2.88f
less than 5 acres $700.96
$674 + $26.96)
less than 10 acres $881.92
Icss than 50 acres Si,167.92
Sn and less than 100 acres
($15. +S60841
Ito acres and more ,5 .on tin
($4395 + $95.80) —J
Annual maintenance fees are assessed in arrears on April I each yea or portion of a year that this permit is uctite
1Code § 17-2081.
711i14, Rcaiscd: 8i29r 14, 10,'1811R, 711,2021,7.26;2021 Pagc I of3
Person(s) attending the Pre -construction Meeting:
Names (type or print) Firm Contact Number or email
SU44llyr C. 70
The second part of the application fee is required to fie paid iviih this request. This fee amount is.
FOk OFFICE [ISF ONIX Permit Inued note
7/ti ]4, Rcvised: 8/?9/14, 10: I8/18. 7/l/2b21, 7l26/2021 11u8c 2 of 3
9/1/2021
Centralized Payments
O Your Payment Was Submitted
Transaction ID:
Transaction Time:
Total Paid:
03S94743P9844802R
09/01/2021 03:42 PM
$719, 24
We will receive notification of your online payment at the time that it is made and we will
credit your payment as of that day. However, you will not see the payment on your
account for approximately 48-72 hours due to the time that it takes to get those funds
into our bank account.
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