HomeMy WebLinkAboutWPO201800093 Application 2018-12-07Virginia Stormwater Management Program (VSMP)OD
Application for Albemarle County
Project Name: Senior Sunrise Living - Addition to the Colonnades
(Tire name should be lire same as it appears on plans)
Major Site Plan Amendment, but
Is this an amendment to an approved plan? Yes ❑ No ® no approved Stormwater/ESC Plan
Is this a revision or resubmission for review? Yes ❑ No m
Comity File Number: TBD (to be provided by the Coanlyfor new applications)
The following are required elements of new applications (from code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
® A. Signature of the Prom Owner for each parcel: (Required with every submission or revision, 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 tight to enter upon the property as required to ensure
compliance with the npproved plans and permits.
06000-00-00-024Eo ✓,(VA FVQA10(T-T1an/ ' \1 //-24, eS-
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name Ti�eu, /�:tytt( Sitar.Ke Ssr•a� L•v:a�
Address. "vZ N.lestMk Dr:ve
City
State VA Zip =02 _
Daytime Phone i( 03) gS4- o tt 3 E-mail 'N". A:e4tr a 144-11
7/1/14, Revised: 7/10/14, 1/7/14 Page 1 of
® B. All Fees [Code section 17-2081
For new or modified plans; Total acres proposed to be disturbed 0.88
Acres to be
Total Fee
Fee Due with this
Fee with Transfer or
'
p c
n of permit
ss Otan ]
1 $290
$145
1 $20
$200
I and less than 5
5 and less than 10
$3,400
$1,700 1
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than 100
$6,100
$3,050
$450
100 and more
$9,600
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
® C. Registration Statement on the official DEQ form.
• D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
® E. Stormwater Management Plan satisfying the requirements of code section 17-403.
® F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
® G. Stotmwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
N/A ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
FN—/A-1 ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
PN—/Aj ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all clans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Draper Aden Associates - Campbell Bolton, P.E.
Address 110 Avon
City Charlottesville
State VA _ Zip 22902
Daytime Phone 4( 34) 295-0700 F-mail ebolton@daa.com
*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.
FOR OFFICE USE ONLY wPo # c9010- 1 j ' I - 1
Fee Amounts Date Paid Z Bywho? n ✓� Receipt#_It101 /-Ckff--/V/�//�-7By.JP
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711/14, Revised: 7/10/14, 1/7/14 Page 2 of 2