HomeMy WebLinkAboutWPO202100063 Preconstruction Form 2023-02-24Request for Pre -construction Meeting and Grading Permit
from Albemarle County — VSMP
Approved Plan Number: WPO- Z021000 G 3
DEQ Permit # (if applicable): VAR I O-,S Wf
Approved Plan Name: „rl( »RQ re e Cle0.rir,c O,.lu P(Mr
(Plans must be approved prior to a pre -construction meeting,)
Bond approved date: Z I V IA-1
(Bonds must be approved and posted prior to a pre -construction meeting or peimit.)
Responsible Land Disturber:
Print Name:
State RLD Number: RLIJ(L O 3y g
Address: 14('2.
City: C knrla GRs AlU
State: V!ft_ Zip: 2.2a I
Daytime Phone:( I'3y)1,�(S`p8'jq X1b6 E-maiL Klw Cc$�yA $0 Jo Q�onTtOn Cswt.
Primary Contractor:
Print Name:
Address: ly?s'`-(-� (la„to(iS IJJ'ir�
City: State: A S/ 1 Zip: Z�zy l
Daytime Phone:( ) 2u[r- 0$9L( 1c106 E-mail:�(w_rs CA^_
Permit Issuance Fees (Request must include payment) [Code ys17-708J:
Total acres proposed to be disturbed as shown on the approved plan and application: G2,77 Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
Total Fee = (Application Fee +4% Technology Surcharge)
Less than 1
$7q 88
Single -Family Dwelling only -
$74.88
less than 5
($72 + $2.88)
1 and less than 5 acres
$700.96
$674 + $26.96)
5 and less than 10 acres
$881.92
(S848 + $33.92)
10 and less than 50 acres
$1,167.92
$1,123 +$44.92
50 and less than 100 acres
4
$1,581.84
($1,521 +$60.84)
100 acres and more
$2,490.80
$2,395 + $95.80
Annual maintenance fees are assessed in arrears on April 1 each year or portion of a year that this permit is active
[Code §17-2081.
7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021, 9/15/2021 Page 1 of 3
Person(s) attending the Pre -construction Meeting:
Names (type or print) Firm Contact Number or email
The second part of the application fee is required to be paid with this request This fee amount is:
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021, 9/15/2021 Page 2 of