HomeMy WebLinkAboutSE202300002 Agreements 2023-02-01Albemarle 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/A
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-ACSA20221306
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: ❑
Authorized ACSA Signature
12/4/22
Date
From: bounce+webmaster=se"iceauthority.ora(alh.atomicsites.net on behalf of Albemarle County Service Authoritv
To: ACSA Locators; savernaanbcllc.mm
Subject: ACSA Building Permit Pre -Application Submittal for 076CO-02-00-00300
Date: Tuesday, November 29, 2022 10:39:52 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: November 29, 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, Virginia 23059
Address of Proposed
20 Deer Path Lane
Work (Tax Map and
Charlottesville, Virginia 22901
Parcel below if no
assigned address):
Tax Map and Parcel:
076CO-02-00-00300
Initial Or Revised
Revised
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
0
Floors With Plumbing
(including habitable
areas above the upper
floor)
Description of Work:
Removing three (3) existing Shentel antennas and installing six (6) new T-
Mobile antennas and related equipment. Removing existing Shentel
equipment cabinet and installing new T-Mobile enclosure and battery cabinet.
Comments: I mistakenly put the wrong address of work on the initial submission. It is
now corrected.
Supporting After submitting this form, if further documents are needed, please e-mail
Documentation supporting documents (Plans, stakeout surveys, etc.) to
Submission locators@serviceauthority.org. Please place "Pre-App Documents" and the
Instructions "Address of Work or Tax Map and Parcel Number" in the subject line. Thank
you.