HomeMy WebLinkAboutWPO201900062 Bond 2022-04-10InternalUseAl
Date to ReReceived:d: Fee Paid: �Y
Received by:
Intake: Forward to Program Administrator
1��ROn�SP
REQUEST TO ESTABLISH A BOND
APPROVED PLAN # WPo 2019-00062
PROJECT NAME: SOUTHWOOD - PHASE 1 - CLEAN EARTH FILL PLAN - NORTH AREA
(As listed on the approved plan)
All parcels in the project, including any off -site work if easements are not provided, and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must be correct, and plans must be
approved prior to bond estimates being prepared.
TAX MAPS / PARCELS:
TAX MAPS / PARCELs:
TAX MAPS / PARCELs:
TAX MAPS / PARCELS:
TAX MAPS / PARCELS:
90A1-1D OWNER'S NAME: OUTHWWOOD CHARLOTTESVILLE, LLC
SIGNATURE:date: 3 Z� 7-7
OWNER'S NAME:DAN ROSENSWEIG
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
date:
date:
date:
date:
NOTE: If ownership of the property is in the name of any type of legal entity or organization
including, but not limited to the name of corporation, partnership, limited liability company,
trust, association, etc., documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so.
The requested estimates are; (Fees include 4% Technology Fee)
❑ VESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; $0 fee
® VSMP Erosion and Sediment Control, Storruwater Management and Mitigation per Water
Protection Ordinance section 17-208; $29432 fee required
❑ Subdivision (roads, drainage, etc.) per Subdivision Ordinance section 14-435;
& Water & Sewer per Subdivision Ordinance section 14-435; $307.84 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
EMAIL: avinisky@a illehabitat.org
OR REGULAR MAIL ADDRESS:
Revised 7/I/21