HomeMy WebLinkAboutWPO202200017 Application 2023-02-13Virginia Stormwater Management Program (VSMP) or
Virginia Erosion and Sediment Control Program (VESCP)
Application for Albemarle County — Online Form Only
Project Name:
664 West Rio
(The name should be the same as it appears on plans)
it
The following is a requirement for a new VSMP or VESCP application [Code §17-401 or 402]. Signatures
must be provided for any .submission.
Signature of the Owner for each parcel: (Required with every submission, 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.
45-100 Toe N - ?ltrts w%/�(/f Z/
Tax Map & Parcel Print Name of wner Si natur of yO�wner Date
45-100A AND 45-100B �� C l� _ '�•� - ,#t �r , / ' � y 0J1023
Tax Map & Parcel Print Name of Owner Si azure of Owner Date
45-101 Ja N 7 u✓ �_ yr�-__ _ r�� $/z(J23
Tax Map &Parcel Print Name of Owner Sig ur of.O/w�ne�r� Date
45-101 B Jvi- F. i eayju?t J r. �//�f'!ry I 2/9 o2�
Tax Man & Parcel Print Name of Owne Siena ure of Owner IDate
* 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within 6 months from the date of county comments, the application will be deemed withdrawn.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. Active permits are subject to annual
maintenance fees 1§17-207 and §17-2081.
Revised 07/1/21; 7/26/2021; 01/05/2022