HomeMy WebLinkAboutWPO201400063 Application 2014-07-07 Albemarle Coc'ty Community Development Department
401 McIntire Road Charlottesville,VA 22902-4596
+, Planning Application Voice: (434)296-5832 Fax: (434)972-4126
PARCEL / OWNER INFORMATION
TMP 02100-00-00-012C1 Owner(s): NEW HOPE COMMUNITY CHURCH; MICHAEL HENDERSON
Application # WP0201400063 TRUSTEE
PROPERTY INFORMATION
Legal Description ACREAGE PARCEL D
Magisterial Dist. White Hall Land Use Primary Forest
Current AFD Not in A/F District Current Zoning Primary Rural Areas
APPLICATION INFORMATION
Street Address Entered By
Todd Shifflett
Application Type Water Protection Ordinances 07/07/2014
Project New Hope Church
Received Date 07/07/14 Received Date Final Submittal Date Total Fees 1350
Closing File Date Submittal Date Final Total Paid 1350
Revision Number
Comments
Legal Ad
SUB APPLICATION(s)
T •e Sub A.•licati Comment
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APPLICANT / CONTACT INFORMATION
ContactTy.e l Name I Address CityState Zip Phone 1 PhoneCell
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Primary Contact MICHAEL HENDERSON 3445 SEMINOLE TRAIL STE. 3 CHARLOTTESVILL 22911 4349627285
Signature of Contractor or Authorized Agent Date
of AL@l,
Virginia Stormwater Manage ,,nt Program (VSMP) ,,��.1.1�� iin
Application for Albemarle County
Required Elements of this application[from code section 17-401]:
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
ErA. Signature of the Property Owner for each parcel: (Required with every submission or revision, 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 I 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.
c - c` / --7/7l/N
Tax Map&Parcel Signature of Owner Date
Tax Map&Parcel Signature of Owner Date
Tax Map&Parcel Signature of Owner Date
Tax Map&Parcel Signature of Owner Date
Contact Information_for the Owner(s)to receive correspondence:
Print Name M o d.-6
Address 3`H r-6\St. 1 c-c, \ Si e . D c�
City Ch.o,c to*4c s J; I (c. State 11 PC) Zip )
Daytime Phone H 3 4{) ci (o a 7 )--E'S E-mail r,-ti 'i k e .),V4 Fc eD vr,vr,;(, r,N
❑ B. All Fees [Code section 17-208]
Total acres proposed to be disturbed
Acres to be disturbed Total Fee Fee Due with this Application
Less than 5 $2,700 $1,350
5 and less than 10 $3,400 $1,700
10 and less than 50 $4,500 $2,250
50 and less than 100 $6,100 $3,050
100 and more $9,600 $4,800
❑ C. Registration Statement on the official DEQ form (attached).
7/1/2014
❑ D. Erosion and Sediment Contra ian satisfying the requirements of code ;tion 17-402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name
Address
City State Zip
Daytime Phone( ) E-mail
*When applications and plans are reviewed,but not approved,and a response to comments is not received within
6 months from the date of county comments,the application will be deemed withdrawn. Applications without
valid owners signatures will not be considered valid.
FOR OFFICE USE ONLY WPO# Dc�l 1` 13 ( p //
Fee Amount$ j1%v.&.Date Paid -7 t/ By who?a/GW ti �'1Ut& Receipt# / 6 Ck# alig By:
7/1/2014