HomeMy WebLinkAboutWPO202100070 Preconstruction Form 2022-07-19Request for Pre -construction Meeting and Grading PermitA
from Albemarle County — VSMP�
Approved Plan Number: WPO- )�b9J 4&o 70 DEQ Permit # (if applicable): VAR10-
Approved Plan Name: , bru \e� 1 fy QQ 4 C`i�l EM rS
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: :Z,b I P-2,
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name: be5ET" 7134 ry t Osj
State RLD Number: e_1g34
Address: A-1 ta40(Ly L 4r"
City: State: VIA- Zip: 2� %9,
IIr
Daytime Phone: 9O 6 E-mail: Cc CC) Ctw1
Primary Contractor:
Print Name: Ft . w t.. A4- ,
Address: ?' 0- '.,WX 1
City: Cl�n�1/1 [ l C, V State: VA Zip: 2--2R0 b
Daytime Phone: fw6b Q71.3i 10o E-mail: + u(jo AC1 d,'j/a,rtf . m-;,,
Permit Issuance Fees (Request must include payment) [Code §17-708]:
Total acres proposed to be disturbed as shown on the approved plan and application: 2 " I % Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
Total Fee = (Application Fee + 4% Technology Surcharge)
Less than 1
$74.88
$72 + $2.88)
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
$1,123 + $44.92
50 and less than 100 acres
$1,581.84
$1,521 + $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].
7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021, 9/15/2021 Page 1 of3
Person(s) attending the Pre -construction Meeting:
Names (type or print) Finn Contact Number or email
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: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021, 9/15/2021 Page 2 of 3