HomeMy WebLinkAboutWPO202200016 Application 2022-04-10Virginia Stormwater Management Program (VSMP) or
Virginia Erosion and Sediment Control Program (VESCP)
Application for Albemarle County — Online Form Only 0
Project Name. ZcoZ-SS ?C� ^' t' t- ""i.' ' ` %`` --T 3 C:
(The name should be the same as it appears on plans)
The following is a requirement for a new VSMP or VESCP application [Code §17-401 or 402]. Signatures
must be provided for any submission.
Signature of the Owner for each parcel: (Required with every submission, NOT TO BE SIGNED
BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I 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 right to enter upon
the property as required to ensure compliance with the approved plans and permits.
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Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature
Tax Map & Parcel Print Name of Owner Signature of Owner Date
* 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within 6 months from the date of county comments, the application will be deemed withdrawn.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. Active permits are subject to annual
maintenance fees 1§17-207 and §17-2081.
Revised 07/1/21; 7/26/2021; 01/05/2022