HomeMy WebLinkAboutWPO202000048 Application 2020-10-14Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
It
Project Name: Mill Creek Industrial Lot 11
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No Rl
Is this a revision or resubmission for review? Yes ❑ No
County File Number: (to be provided by the County for 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.
RA. Signature of the 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 right to enter upon the property as required to ensure
compliance with the approved plans and permits.
76M 1-11
Tax Map 1
Tax Map &
Creek Industrial Develo
Name of Owner
Name of Owner
Signature of Owner
9/30/20
Vate
Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Mill Creek Industrial Development LLC
Address 11155 Fifth Street SW, Suite C
City Charlottesville
Daytime Phone (__) E-mail
VA 7m 22902
Revised 07/24/18 Page 1 of 2
r
0 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 0.97 AC
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than 10
$3,400
$1,700
S250
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
Mitigation Plan; $150
® C. Registration Statement on the official DEQ form.
P 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. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies ofall plans 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 SCOTT COLLINS - COLLINS ENGINEERING
Address 200 GARRETT STREET, SUITE K
City CHARLOTTESVILLE State VA Zip 22902
Daytime Phone 4( 341 293-3719 E-mil scoff@collins-engineering.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 N
Fee Amount $�'�_Date Paid I tJl Fi' By who c�t �L/T1Ckg4_l, uBy:
Revised 07/24/18 Page 2 of 2