HomeMy WebLinkAboutSE202200061 Agreements 2022-10-20Albemarle County
Service Authority
Serving*Conserving
ACSA Application Number:
ACSA Building Permit Pre -Application Review
Proper Permit Documentation Submitted by Applicant: YES W/I NO
RWSA Approval Granted: YES ❑ NO ❑ N/A F
RWSA Comments Attached: YES ❑ N/AFv
ACSA Jurisdictional Area Designation: Water and Sewer
ACSA Utility Connection(s) Approval (if applicable):
Sewer Connection Fee Special Conditions (if applicable):
Backflow Requirements (if applicable):
Sewer Discharge Permit Requirements (if applicable):
Comments:
PA-ACSA2O220980
This document must be submitted at the time of Building Permit application to the County of Albemarle. Any revisions to the scope
of work approved under this ACSA Building Permit Pre -Application requires a revision submittal to the ACSA for re -approval, prior to
a Building Permit revision application to the County of Albemarle. This Pre -Application becomes null and void if application for a
Building Permit is not commenced within 6 months of the approval date.
Application Review Status:
Approved:
Denied: ❑
AM,mofer J Morrison, T U. dm ov civil Engineer
8/16/2022
Authorized ACSA Signature Date
Last Revised: September 16, 2021
From: bounce+webmaster=se"iceauthority.ora(mh.atomicsites.net on behalf of Albemarle County Service Authoritv
To: ACSA Locators; savernaanbcllc.mm
Subject: ACSA Building Permit Pre -Application Submittal for 05600-00-00-017CO
Date: Tuesday, August 16, 2022 9:53:26 AM
CAUTION: This email originated from outside the ACSA. Do not click links or open
attachments unless you recognize the sender and know the content is safe.
Date: August 16, 2022
Applicant Name:
Sam Avema (Agent for T-Mobile)
Contact Person:
Sam Avema
Contact Phone:
5713405493
Contact Email:
savema@nbcllc.com
Applicant Address:
120 Eastshore Dr. Suite 300
Glen Allen, Virginia 23059
Address of Proposed
5941 Rockfish Gap Turnpike
Work (Tax Map and
Crozet, Virginia 22932
Parcel below if no
assigned address):
Tax Map and Parcel:
05600-00-00-017C0
Initial Or Revised
Initial
Submittal:
Submittal Type:
ATWR— Alteration to Tower
Water Supply:
None
Sewage Disposal:
None
Irrigation System
No
Proposed:
FOG Device Proposed
N/A
(if applicable):
Total Number of Floors
0
With Plumbing
(including habitable
areas above the upper
floor)
Description of Work:
Replace existing T-Mobile antennas with newer models.
Supporting
After submitting this form, please a -mail supporting documents (Plans,
Documentation
stakeout surveys, etc.) to locators@serviceauthority.org. Please place "Pre-
Submission Instructions App Documents" and the "Address of Work or Tax Map and Parcel
Number" in the subject line. Thank you.