HomeMy WebLinkAboutWPO202200005 Preconstruction Form 2023-03-09Request for Pre -construction Meeting and Grading Permit a
from Albemarle County — VSMP , y I�
Approved Plan Number: WPO-a?i�W 0! DEQ Permit # (if applicable): VAR 10- J / 7O
Approved Plan Name: u Q d mi(t, ra,
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: d -023 `" X,33
(Bonds must be approved and posted prior to a pre -construction meeting or permit.)
Responsible Land Disturber:
Print Name:
State RLD Number:
Address: 4
City: _
"51,/ —
Stater Zip: 19aoaq
Daytime Phone: �T?�- E-mail: C Q(/Q L
Primary Contractor:
Print Name:%ir l� /If T111
Address:
City:
Daytime Phone: (___)
E-mail:
State:
Zip:
Permit Issuance Fees (Request must include payment) [Code §17-7081:
Total acres proposed to he disturbed as shown on the approved plan and application: /J. /Okcres
Total Fee Due for Grading Permit
Acres to be Disturbed
Total Fee=(Application Fee+4% Technology Surcharge)
Less than 1
$74.88
$72 + $2.88
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
($848 + $33.92
10 and less than 50 acres
$1,167.92
$1,123 + $44.92
50 and less than 100 acres
$1,581.84
($1,521 + $60.94)
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, 7/1/20211 7/26/2021, 9/15/2021 Page 1 of 3
Person(s) attending the Pre -construction Meeting:
Names (type or print) Finn 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/l/2021, 7/26/2021, 9/15/2021 Page 2 of
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