HomeMy WebLinkAboutWPO201900057 Application 2022-12-14Virginia Stprmwater Management P
Applicatio
Project Nam
for Albemarle County
: PROFFIT ROAD TOWNHOMES
(The name should be the same
Is
this an am
ndment,
modification, or
tran
Is
this
a resu
mission
for review? Yes
❑ N
County File
umber: WPO-2019000057
ram (VSMP)
4ORTH
is it appears on plans)
fer of an approved plan? Yes E No ❑
0
to be provided b11 the County_for- new applications)
The following are required elements of new ap lications [§17-401]. For amendments and resubmissions,
please indicat which items are being amended Signatures must be provided for any submission.
52 A. Sign
AN A
of the Owner for each parcel:
ENT OR CONSULTANT)
uired with every submission, NOT TO BE SIGNED BY
By sign ing this application as the owner, I he -eby certify that all requirements of these plans and permits will be
compli d with, and I have the authority to authorize the land disturbing activities and development on the subject
property. I hereby grant the County of Alber iarle the right to enter upon the property as required to ensure
compli nce with the approved plans and per nits.
/ELOMENT LLC �&4 a& l O�t�•a
TM 342
Tax M
Tax M
Tax
2-2
& Parcel
& Parcel
& Parcel
Tax Mab & Parcel
Contact
ALBEMARLE LAND D
Print Name of Owner
Print Name of Owner
Print Name of Owner
Print Name of Owner
for the Owner(s) to recei
Print Naime: BRENT HALL
Addressi 1949 NORTHSIDE DRIVE
City: C
Da
RLOTTESVILLE
Phone: ( )434-996-3911
Signature of Owner
Date
Signature of Owner
Date
Signature of Owner
Date
Signature of Owner
Date
correspondence:
-mail:
hall
State: VA Zip: 22911
nc.com
n _ _ .. - - 1 n ^7 I 1 Yl 1 . -I 11% I M n % 1 . A 11 /
❑ B. All Fe s [Code § 17-208]
For new or mo ified plans: Total acres
to I be disturbed 15-60
to be Disturbed
Fee Due with this
Application
Transfer or
Modification Fee
Total Fee = (Application Fee + 4% Technology Surcharge)
Si gle Family Dwelling only $171,60 $23.92
L ss than 1 acre ($165 + $6.60) $23 + $0.92)
Si gle Family Dwelling only $171.60 $236.08
1 nd less than 5 acres ($165 + $6.60) ($227 + $9.08)
L
ss than 1 acre
$171.60
$20.80
($165 + $6.60)
($20 + $0.80)
1
and less than 5 acres
$1,591.20
$236,08
($19530 + $61.20)
($227 + $9.08)
5
d less than 10 acres
$29004,08
$294.32
($11927 + $77,08)
($283 + $11.32)
10
and less than 50 acres
$2,652.00
$353.60
$2,550 + $102
$340 + $13.60
50
and less than 100 acres
$3,596.32
$530.40
($3,458 + $138.32)
($510 + $20.40)
10
0 acres or more
$5,657.60
$824.72
($51440 + $217.60)
($793 + $31.72)
❑ C. Amen ments to an approved plan. Fee $23608 per review ($227 fee + $9.08 technology surcharge)
❑ D. Registration Statement on the official D Q form.
❑
E.
Erosion
and
Sediment Control
Plan satisfying
the requirements of Code § 17-402.
F.
Stormwater
Management Plan
satisfyin
the requirements of Code § 17-403.
❑
❑ G. Pollution Prevention Plan satisfying the
❑ H. Stormwater Pollution Prevention Plan s
111. Mitiga ion Plan satisfying the requiremi
stream buffers. $176,80 ($170 fee + $6.80 tec
❑ J. Reque t
ed Variations or Exceptions as
technolosurcharge)
Provide 2
seals must
Additional i
uirements of Code § 17-404.
tisfying the requirements of Code § 17-405.
nts of Code § 17-406 for any proposed disturbance of
urology surcharge)
-ovided in Code § 17-407 and § 17-408. $176,80 ($170 fee + $6.80
es of all plans and any supportin7 documents or submit all documents online. Professional
e original signatures.
�rmation if not provided on plans and documents:
Name of a Contact Person for correspondence (usually
Name ( rint): JUSTIN SHIMP
Address 912 E. HIGH ST
City: CF ARLQTTESVILLE
plan preparer, consultant, or agent):
te: VA Zip: 22902
Daytime Phone: ( )434-277-5140 E mail: Justin@shimp-engineering.com
* When applicai ions and plans are reviewed, but not approved, and a response to comments is not received within 6
months from th date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will lot be considered valid. Active permiti are subject to annual maintenance fees [§ 17-2081.
FOR OFFICE USE ONLY WPO #
Fee Amount
Paid By who?
ceipt # Ck# By:
In_: -A n �l f 1 111 0 . 07 /n C 1.1 n^1 1 . A !'1 C /'1 n'1'1