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HomeMy WebLinkAboutWPO201400065 Application 2014-08-04 Virginia Stormwater Management Program (VSMP) for Albemarle County 114:0. Project Name: O UPNOICS of 14-w&rt,t.S 114oN►ok-.STraxj (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No 21 Is this a revision or resubmission for review? Yes El No ❑ County File Number: .Q' .1.( 4[)00 S (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. L3/A. 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. 11 '' C�(STE.Q-�vt..J loci`s b r T II 27 - `f0ki 9021 Gr 0►3Sia124, Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Address City State Zip Daytime Phone( ) E-mail 7/1/14,Revised: 7/10/14 Page 1 of 2 Sore ./B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed '2— 0 Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 &C. Registration Statement on the official DEQ form. pQAptou.ski Sll,bw. ) F �D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. �E. Stormwater Management Plan satisfying the requirements of code section 17-403. N121F. Pollution Prevention Plan satisfying the requirements of code section 17-404. (27G. 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. VI. Requested Variations or Exceptions as provided in code sections 17-407 and 408. 1 AP°a-- Cu-b$44t ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. 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) Print Name la610S pAz.+— C. /'V1 4.Ill "ex p. 7. Address '7I 1$40114-oc.Lr10 !td•fto City 6ttrAv la H Sv. /l C, State V ri- Zip 7"Z-5°7-- Daytime Phone(4/A 77—C-'0 5 E-mail •C M,.."5 co. C c) Yo,A.d hcu1. coot, *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14 Page 2 of 2 Albemarle COL,,, �"V Community Development Department °"'! 401"!rentire Road Charlottesville,VA 22902-4596 tl` Planning Application Voice:(434)296-5832 Fax:(434)972-4126 PARCEL/ OWNER INFORMATION TMP 02700-00-00-040A1 Owner(s): CISTERCIAN NUNS OF THE STRICT OBSERVANCE IN Application # WP0201400065 VIRGINIA INC C/O REV MOTHER MARION RISSETTO PROPERTY INFORMATION Legal Description ACREAGE Magisterial Dist. White Hall Land Use Primary Residential --Single-family (incl. modular homes) Current AFD Moorman's River Current Zoning Primary Rural Areas APPLICATION INFORMATION Street Address 712 LANDSDALE LN CROZET, 22932 Entered By Todd Shifflett Application Type Water Protection Ordinances 08/04/2014 Project Our Ladies of The Angels Monastery Received Date 08/01/14 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) Type I Sub Applicati Comment Stormwater Management/BMP Plan (APPLICANT/ CONTACT INFORMATION ContactType J Name I Address I CityState f Zip Phone PhoneCell owner/Applicant 1 CISTERCIAN NUNS OF THE STRICT OBS :3365 MONASTERY DRIVE i CROZET VA ,22932 Primary Contact rY SHANK&GRAY-RICHARD 510 EAST MAIN STREET CHARLOTTESVILL 22902 4342950131 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) Application for Albemarle County il�fi • Project Name: L)1,4 tc C'to c of 71/C i i 4 A e t °1 N A) /WO �,,../ (The name should be the same as it appears on plans) ,/ Is this an amendment to an approved plan? Yes ❑ No Is this a revision or resubmission for review? Yes ❑ No*. County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011 For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any �suubmission. © A. 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. :Ti:+t-(,,4Cy-l ►J tit4t. /,r /—/Ilitk `�'f al.t + t�/1* k G r ti ?6,04Inll, rYU✓t.�r tiatt Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for ta th�e/Owner(s)to receive correspondence: Print Name Make/Make/ ,A -*I o rl I Ss dr Address 334 1on4S-t. b'i✓z City Cr°'.- ,/State V A Zip ,22 93:x• Daytime Phone(43Y f a.3 I4- E-mail 111 Nl aP r 010 0!a ih 0 r14sre�y.Ofj 7/1/14,Revised:7/1 0/1 4 Page I of 2 • 1Z B. All Fees [Code section 17-208] 2 For new or modified plans;Total acres proposed to be disturbed Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than I $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 ❑ 5. Registration Statement on the official DEQ form. D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. li E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name SJ}AnJYL 4 62Ay Address 4510 EPt i toA-t,-1 T -e / City etAA-1 ,1 i ?,,"V 1 1—� VII I Lip 2.2-5 i?"2- Daytime Phone( ) )5 0131 E-mail /C i,..441'7 t^ (3 ' H-$<JW/.er -t,!, e c *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 signatures will not be considered valid. FOR OFFICE USE ONLY WPO# . Fee Amount$13Q/04 Date Paid Si t Ili By who?54140 k 4 a f0, Receipt#91p(.2 1 Ck#6Db Cp By: .t____ A re.11;.u4 S ,`� 7/1/14,Revised:7/10/14 Page 2 of 2