HomeMy WebLinkAboutWPO202200036 Application 2022-08-12cr ai,
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County * ~
Project Name: Overlook Hotel
(The name should be the same as it appears on plans)
Is this an amendment, modification, or transfer of an approved plan? Yes ❑ No
Is this a resubmission for review? Yes ❑ No a
County File Number: WPO-,
be provided by the Countyfor new applications)
The following are required elements of new applications [§]7-401]. For amendments and resubmission,
please indicate which items are being amended. Signatures must be provided for any submission.
❑ A. Signature of the Owner for each parcel: (Required with every submission, 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 1 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.
78-73A7
Tax Map & Parcel
78-13A
Tax Map & Parcel
WS FOUR LLC
Print Name of (
HAPPY BOXES LLC
Print Name of Owner
Tax Map & Parcel Print Name of Owner
Signature
Signature of Owner
Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence
Print Name: Doug Ellis
Address: 3600 Pacific Ave
City: Virginia Beach State: VA zip: 23451
Daytime Phone: (757)754-4878 E-mail: dou @g subcap.com
Revised 07/l/21; 7/26/2021; 4/26/2022
❑ B. All Fees [Code § 17-208]
For new or modifiedplans: Total
nca.i to ha,Iieh,rl M 2.87 ae
Fee Due with this
Transfer or
Acres to be Disturbed
Application
Modification Fee
Total Fee = (Application Fee + 4% Technology Surcharge)
Single Family Dwelling only
$171.60
$23.92
Less than 1 acre
($165 + $6.60)
S23 + $0.92
Single Family Dwelling only
$171.60
$236.08
1 and less than 5 acres
($165+$6.60)
($227+$9.08)
$171.60
$20.80
Less than 1 acre
(S165+$6.60)
($20+$0.80)
$1,591.20
$236.08
1 and less than 5 acres
($1,530+$6 L20)
($227+$9.08)
$2,004.08
$294.32
5 and less than 10 acres
($1,927 + $77.08)
(S283 + $11.32)
10 and less than 50 acres
$2,652.00
52550+$102
$353.60
$340+S13.60
$3,596.32
$530.40
50 and less than 100 acres
($3,458+$138.32)
($510+$20.40)
$5,657.60
$824.72
] 00 acres or more
(S5,440+$217.60)
($793+$31.72)
❑ C. Amendments to an approved plan. Fee = $236.08 per review ($227 fee + $9.08 technology surcharge)
❑ D. Registration Statement on the official DEQ form.
❑ E. Erosion and Sediment Control Plan satisfying the requirements of Code § 17-402.
❑ F. Stormwater Management Plan satisfying the requirements of Code § 17-403.
❑ G. Pollution Prevention Plan satisfying the requirements of Code § 17-404.
❑ H. Stormwater Pollution Prevention Plan satisfying the requirements of Code § 17-405.
❑ 1. Mitigation Plan satisfying the requirements of Code §17-406 for any proposed disturbance of
stream buffers. $176.80 ($170 fee + S6.80 technology surcharge)
❑ J. Requested Variations or Exceptions as provided in Code §17-407 and §17-408. $176.80 ($170 fee +$6.80
technology surcharge)
Provide 2 conies of all plans and any supporting documents or submit all documents online. 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):
Name (Print): Chris Marshall
Address: 912 E Huh St
City: Charlottesville State: VA Zip; 22902
Daytime Phone: (434 997-5140 E-mail: Chris@skimp-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
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signatures will not be considered vatta. Active permits are sauJcca to annua, ...a.n.onau..c 10 is . I -......t.
FOR OFFICE USE ONLY WPO #
Fee Amount $ Date Paid By who? Receipt # CV -By: