HomeMy WebLinkAboutWPO202200013 Application 2022-11-14Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: TJACH PREMIER CIRCLE
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes 0 No M
Is this a revision or resubmission for review? Yes El No Ell
County File Number:
(to be provided by the Countyfor new applications)
Thefollowing are required elements of new applications ffrom code section 17-4011. For revisions or
amendments, please indicate which items are being amended. Signatures must be providedfor any
submission.
M A. Signature of the Propegy Owne 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. n
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Tax Map & Parcel Print Name of Property Owner Signature of Owner
Contact Information for the Owner(s) to receive correspondence:
Print Name PEIDMONT HOUSING ALLIANCE (Attn: SUNSHINE
Address 682 BERKMAR CIRCLE
city Charlottesville
Date
Date
Date
Date
State VA Zip 22901
Daytime Phone (434) 817-2436 —E-mail SMATHON@PIEDMONTHOUSING.ORG
7/1/14, Revised: 7/10/14, 1/7/14 Pagel of 2
00 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 1.75 Acres
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
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
S2,250
$300
50 and less than 100
$6,100
S3,050
$450
100 and more
$9,600
S4,800
$700
For (minor) amendments to an approved plan, $200 per review
Variances, $150 (per request)
Mitigation Plan, $150
E] C. Registration Statement on the official DEQ form.
Z D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
91 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
E] F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
E] G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
El H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
El 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
El J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 Mpies ofall plans and any supporting documents. Professional seals must have original
signatures.
Additional information ifnot provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Jonathan Showalter, PE
Address 608 Preston Ave, Suite 200
City Charlottesville
State VA Zip 22903
Daytime Phone (434) 327-1681 -E-mail jonathan.showalter@timmons.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
signatures will not be considered valid.
FOR OFFICE USE ONLY
WPO #
Fee Amowt $_ Date Paid — —
— — -- By who?
Receipt 4 Ck#
By:
7/1/14, Revised: 7/10/14, 1/7/14 Page 2 of 2