HomeMy WebLinkAboutWPO202100033 Preconstruction Form 2022-08-10Request for Pre -construction Meeting and Grading Permit
from Albemarle County — VSMP �a �`^•`
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Approved Plan Number: WPO- ;:�QP& QD33 DEQ Permit # (if applicable): VAR10- IZL) _�_
Approved Plan Name: I t'p.Lp 1) V 1 Jn
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: L vim, ,, c � _'S , ;?Q 2 D_
(Bonds must be approved andpos d prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name:
State RLD N
Address: ( 3 rY5 - -Dr.
City: Sr o su,� f ' I State: �(� Zip:
Daytime Phone: � q�I- al)E-mail: rl ru.1o�cr}ru.,' �oawvcu] CAM
Primary Contractgr:
Print Name:
Address:
City: �Go I t SV I'1
State: t/A Zip:.ZyS ld
Daytime Phone: 6ILD 14 ) Z- 0310 `1 E-mail: +rotel t jParMS �4f^ c�� • �✓t l
Permit Issuance Fees (Request must include payment) [Code §17-7081:
Total acres proposed to be disturbed as shown on the approved plan and application: Z3� Acres
Total Fee Due for Grading Permit
Acres to be Disturbed
Total Fge = (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 of
Person(s) attending the Pre -construction Meeting:
Names (type or print) Firm Contact Number or email
���ts /ZTrnL.��c c p. n ItnscP Fx�y3q- 981- mall
The second part of the application fee is required to be paid with this request. This fee amount is:
9U_
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/l/14, Revised: 8/29/14, 10/18/18, 7/l/2021, 7/26/2021, 9/15/2021 Page 2 of: