HomeMy WebLinkAboutWPO201000057 Application 2013-06-21Application for Review of
Erosion & Sediment Control Plan & Stormwater Management/BMP Plan &
Stream Buffer Mitigation Plan
❑ Erosion & Sediment Control Plan
j$( E&S Plan Amendment
(Previous Plan # 2OW -57 1
❑ E&S Plan with Variance
# of Variances
❑ E&S Plan Resubmittal
WPO Application #
❑ Stormwater Management/BMP Plan ❑ Stream Buffer Mitigation Plan
❑ SWM Plan Amendment
(Previous Plan # )
❑ Request for Exception
❑ SWM Plan Resubmittal
WPO Application #
Submit 2 copies each of applicable plans/narrative/computations
*When a WPO plan is reviewed, but not approved, and a response to comments is not received within 6 months from the date of
county comments, the application will be deemed withdrawn.
Project Name: kik ch( 19 0 f' m m LA i Gib+
Tax map and parcel: 11 - >4 Zoning:
Amount of Land Disturbance: L Acme's �^
Location of property (landmarks, intersections, or other): �t Fd)I JLPQ��C T G> P.1.1
Contact Person (Who should we call/write concerning this project?): Se# celiha`- allik$ Ct19°D10Edak6
Address
Daytime Phone O
Owner of Record Awn
Address F0 661
Daytime Phone (___) Fax # (_)
Contractor
Address //0 CA&'t AIA)i )PIC& F'
Daytime Phone (4�fj �M • -/60V Fax # C __)
Plan Preparer
Daytime Phone ckft Fax# C__)
City
State Zip
City %I'll t e #eSv; d e, Star. VA Zip ggrjG
E-mail
City , ArIch,`jde State VAZip Zg1dZ
E-mail
City ehewh eS;,s` a StateVk Zip =qLg
E-mail Sered toIILW--BM4rneertheram
Jj
Owner/Applicant Must Read and Sign
By signing this application as owner, I hereby certify that all requirements of the approved Erosion Control Plan, Stormwater
ManagementBMP Plan, and/or Mitigation Plan will be complied with and I have the authority to authorize the land disturbing activities and
developmen on the su jject property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliane it theal rove plan. &
Signature of Owner, Contlact Purchaser Date
44I4-t_ 'lz-tl, Y✓ Lf 3 `! -)- y s-- 3 r.
Print Name Daytime phone number of Signatory
FOR OFFICE USE
/^1ONLY { WPO #
2
Fee Amount $� Date Paid 6 A _ PBy who? C1< t e eceipt # i9 67? Ck#_LR�L_ By:_K_jr_
Revised November 14, 2011 Page 1 of 3
EROSION CONTROL PLAN: (SUBMIT 2 COPIES)
Land disturbing activity pertaining to single family dwelling unit:
1. Plan Review....................................................................................................................... $150 per review
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
2 Permit and First Year Inspection Fees............................................................................... $150
(TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION
CONTROL PERMIT)
3. Annual Permit Renewal and Inspection Fees.................................................................... $150
(TO BE PAID ANNUALLY, STARTING WITH SECOND YEAR, UNTIL COMPLETION OF APPROVED
PLAN REQUIREMENTS)
4. Each reinspection...............................................................................................................$150
(REINSPECTION FEES ARE INVOICED TO THE LANDOWNER)
Land disturbing activity pertaining to non-exempt agricultural land:
5. Plan Review .................................. ....... $150 per review
..............................................................................
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
6. Permit and First Year Inspection Fees .................,
(TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION
CONTROL PERMIT)
...... $150
7. Annual Permit Renewal and Inspection Fees.................................................................... $150
(TO BE PAID ANNUALLY, STARTING WITH SECOND YEAR, UNTIL COMPLETION OF APPROVED
PLAN REQUIREMENTS)
8. Each reinspection............................................................................................................... $150
(REINSPECTION FEES ARE INVOICED TO THE LANDOWNER)
All other land disturbing activity:
9. Plan Review, Disturbed Area Less Than One Acre ........................................................... $150 per review
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
10. Permit and First Year Inspection Fees, Disturbed Area Less Than One Acre ................... $200
(TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION
CONTROL PERMIT)
11. Annual Permit Renewal and Inspection Fees, Disturbed Area Less Than One Acre........ $200
(TO BE PAID ANNUALLY, STARTING WITH SECOND YEAR UNTIL COMPLETION OF APPROVED
PLAN REQUIREMENTS)
12. Plan Review, Disturbed Area One Acre or Larger.......................................................... $$3 0 per revie
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
13. Permit and First Year Inspection Fees, Disturbed Area One Acre or Larger .................... $100/per disturbed acre
(TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION
CONTROL PERMIT)
14. Annual Permit Renewal and Inspection Fees, Disturbed Area One Acre or Larger.......... $100/per disturbed acre
(TO BE PAID ANNUALLY, STARTING WITH SECOND YEAR, UNTIL COMPLETION OF APPROVED
PLAN REQUIREMENTS)
15. Each reinspection.....................................................
(REINSPECTION FEES ARE INVOICED TO THE LANDOWNER)
.................. $250
16. Amendment to Approved Plan .......................................................................................... $180/per plan review
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
17. Variances ......................................
(TO BE PAID AT TIME OF APPLICATION)
18. SUBTOTAL EROSION CONTROL PLAN
........ $150/per request
$ Gov
Revised November I4, 2011 Page 2 of 3
STORMWATER MANAGEMENTBMP PLAN & MITIGATION PLAN: (SUBMIT 2 COPIES)
19. Stormwater Management/ BMP Plan...............................................................................
$300/per plan review
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
20. Major Amendment of Plan ................................................................................................
$180/per plan review
(TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL)
21. Request for exception.......................................................................................................
$240
(TO BE PAID AT TIME OF APPLICATION)
22. Request for development in a stream buffer or for reduction or modification of stream
buffer and mitigation plan (if not part of another document) — Single family dwelling unit
or accessory structure.........................................................................................................
$85
(TO BE PAID AT TIME OF APPLICATION)
23. Each inspection or reinspection..........................................................................................
$60
(INSPECTIONIREINSPECTION FEES ARE INVOICED TO THE LANDOWNER)
24. Mitigation Plan .................................................................................................................$150
(TO BE PAID AT TIME OF APPLICATION)
25. SUBTOTAL SWMBMP PLAN.....................................................................................S
TOTAL APPLICATION FEE: (Add lines 18 and 25).............................................. $ ';�P A
THE OWNER SHALL BE RESPONSIBLE FOR ALL REINSPECTION AND/OR ANNUAL RENEWAL
FEES WHICH MAY BE CHARGED TO THIS PROJECT.
Revised November 14, 2011 Page 3 of 3