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COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road
Charlottesville, Virginia 22902-4.59fi
Phone(434)296-5832 Fax (434)972 4126
FLOODPLAIN DEVELOPMENT PERMIT
This fonn is intended to aid the Department in documenting; and characterizing the nature of development proposed in the
floodplain. Development includes buildings or other structures, mining, dredging, filling, grading, paving, excavation or
drilling operations or storage ofequipment or materials. The form responses will be used to determine whether a
floodplain impact plan or special use permit is required.
Please check one: ® Nev, Submittal with no anticipated floodplain impact (no floodplain impact plan)
❑ New Submittal with an anticipated floodplain impact. Please Include a/loodplain impact
plan. FEE required with submittal: S323 (Code 18-35.1g)
❑ FE MA Letter of Map Change (LONIA, LOMR) Please include a complete copy ofall
material to be submitted to FEAM. Include any computer models IHEC-R,49.1les11 on a disc.
FEE required with submittal. $161 (topographic info only), or $323 ('floodplain
modeling)
❑ New Submittal with a Zoning Special Use Permit. Please include afloodplain impact plan.
FEE required with submittal: $323
❑ Resubmittal (Floodplain Development Permit Number _ ) Please include vour
reslyonse form froer the original submittal. FEE as above required with each resubmittal.
A Floodplain Impact Plan, Special Use Permit, or FEMA Map Change will need to follow Zoning Floodplain Overlay
District requirements (County Code 18-30.3), found at
http:,,hvvv-Nv.albemarle.ore/upload/imaees/Forms Center/Departments/County Attorney/Forms/Albemarle County Code.
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Section 4 of -the Design Standards Manual provides a list of required items to be included in a Floodplain Impact Plan.
This can be found at http:"tsvww albemarle or department asp'department=cddvti Le-Ip4y=;ski j.
LLC
Owner Name
36 Old Farm Road
Address
Home Phone
434.
/ Other
Charlottesvillle VA 22903
City State Zip Code
Tax Map & Parcel Number 57-31A
Project Name (if applicable) Mechum's
Building Permit or Project Number (if applicable) NIA
IP/201 s
Please describe the nature of the development activity proposed within the tloodplain (e.g. new structure, grading for a
playing field, driveway stream crossing, installation of a lence, etc.):
contractor, has site -verified the area
t ensure-lhaftFie no--filf/no nse cones ii
(Please attach any plans or photos to this application)
Exhibit i all areas "nk bLe nd ract Thwrp_tg„
and will remove 2" of
1. If a structure is proposed. is the structure accessory to a recreational or agricultural use?
2. Does the proposed activity involve a stream crossing for a pedestrian trail or driveway
serving a single family dwelling?
3. Does any proposed fencing cross a stream channel?
J. If any till is proposed, ple a ap orimate the proposed amount of till in the floodplain
Owner / Agent Signature ` �� Date
Paull t-t- % •i r v� la t �l��t rt `� .
(FOR OFFICE USE ONLY)
Checked By
(for resuhmittals) Fee Amount $ Date Paid By Who?
Receipt # _. Chet
Yes ❑ No ✓❑ N/A
Yes ❑ No ❑✓ N/A
Yes ❑ No ❑✓ N/A
no fill proposed
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LANDSCAPE & LIGHTING PLAN
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FINAL SITE PLAN/ARB SUBMITTAL
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