HomeMy WebLinkAboutWPO201300040 Preconstruction Form 2022-04-06os
Request for Pre -construction Meeting and Grading Permit ncy� ��
from Albemarle County — VSMP 0
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Approved Plan Number: WPO- 1X)1 : i [9(Y3 ![L_DEQ Permit # (if applicable): VARI O- 7Z�
Approved Plan Name:
(Plans must be approved prior to a pre -constructs n meeting)
Bond approved date: 4- 1d - _:�_ -2--
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name:
State RLD Number:
Address: Cis/. (-, =f=n = 14CK-5 :r_1 Q A, Y P ( o f
City: ov✓ LO 74� Y. 1,6 State:_
Daytime Phone:6K) i77- 6778 '1 -mail: OriWA,.5' CpYU/
Primary Contractor: A(50 12LD at rA)te� RZ 00 b'�ICn
Print Name:
Add
City
M
Daytime Phone: / — 7%/ `7/ E-mail:
Permit Issuance Fees (Request must include payment) [Code §17-708].•
Total acres proposed to be disturbed as shown on the approved plan and application:-:1/ /O Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
'rota] Fee = (Application Fee + 4^^%Technology Surcharge)
Less than 1
$74 88
($72 + $2.88)
Single -Family Dwelling only —
less than 5
$74.88
($72 + $2 88)
1 and less than 5 acres
$700.96
($674 + $26.96)
5 and less than 10 acres
$881.92
(---- + $33.92)
10 and less than 50 acres
$1,167.92
($1,123 + $44.92)
50 and less than 100 acres
$1,581.84
($1,521 +$60.84)
100 acres and more
$2,490.80
Annual maintenance fees are assessed in arrears on April 1 each year or portion of a year that this permit is active
[Code §17-208].
7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021, 9/15/2021 Page I of 3
Person(s) attending the Pre -construction Meeting:
Names (type
or print)/ 1 Firm Contact Number or email
C. T. C �/ I lJ%3/ �i su/Ti� L L i P✓ i.i �.sl C i—
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The second part of the application fee is required to he paid with this request. This fee amount is:
FOR OFFICE USE ONLY Permit Issued Date
By who?
9/11/2017, 7/l/2021, 9/15/2021 Page 3 of 4