HomeMy WebLinkAboutWPO202100064 Preconstruction Form 2022-05-06Request for Pre -construction Meeting and Grading Permit a
from Albemarle County — VSMP
Approved Plan Number: WPO- Inzi QCD6-1 DEQ Permit # (if applicable): VARI0-
Approved Plan Name: ,�) � 1 6 e_Z -+
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: mt.
(Bonds must be approved mid poste 4rior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name:
State RLD N
Address:
City:
) co :A4-v ,z- 171r.. a .
State: 6��i Zip:
Daytime Phone: "5� C'1 / /[ 5 E-mail: �1 l' 66. tljx�i fLL,
Primary Contractor:
Print Name:
Address:
1Sc
City: r1 w L _3 (] / Lr--
Daytime Phone: o_o l t) -� E-mail:
Permit Issuance Fees (Request must include payment) [Code §17-708]:
State: - V4 Zip:1-7 ZiG z
Total acres proposed to be disturbed as shown on the approved plan and application: Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
Total Fee=(Application Fee+ °t I •Surcharge)
Less than 1
74.88
$72 + $2.8
Single -Family Dwelling only —
74.88
less than 5
($72 + $2.88)
1 and less than 5 acres
$700.96
$674 + $26.96
5 and less than 10 acres
$881.92
($848 + $33.92)
10 and less than 50 acres
$1,167.92
$ 1123 + $44.92
50 and less than 100 acres
$1,581.84
$ 1521 + $60.84)
100 acres and more
$2,490.80
($2,395 + $95.80)
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].
(C:,_7
7/1/14. Reviser- R/29/14. 10/19/1R. 7/l/2021.7/26/7.021.9/150.021 Pane t of
Person(s) attending the Pre -construction Meeting:
Names (t),pe or print) Firm Contact Number or email
C)<h.\liLiL I )iL
-Ak_ nlsS Co"A
�., r6, r -r- L wco eq 1 11i l !fit f 1 ^ 4' ��i i �: V! /i7 v.?w i (c �- era c ,M
L
The second part of the application fee is required to be paid with this request. This fee amount is:
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/1/14. Revised! R/29/14. 10/19/1R. 7/l/2021. 7/76/2021. 9/15/2.021 Pave 2 of