HomeMy WebLinkAboutWPO202200042 Bond 2023-03-17Internal Use Ont,
Date Received: _
Received by: _
Fee Paid:
Intake: Forward to Program Administrator
REQUEST TO ESTABLISH A BOND
APPROVED PLAN # W 90 `Zo 27- - 000 L J 22
PROJECT NAME: &( ,, e iku 2 S b�flcL 19 L4.e- a-ou l 11SM e
(As listed on the approved plan)
All parcels in the project, including any off -site work if easements are not provided, and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must be correct, and plans must be
approved prior to bond estimates being prepared.
TAX MAPS / PARCELs:
TAX MAPS / PARCELs:
TAX MAPS / PARCELs:
TAX MAPS / PARCELs:
TAX MAPS / PARCELs:
_OWNER'S NAM 0
SIGNATURE: dater
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
OWNER'S NAME:
SIGNATURE:
date:
date:
date:
date:
NOTE: If ownership of the property is in the name of any type of legal entity or organization
including, but not limited to the name of corporation, partnership, limited liability company,
trust, association, etc., documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so.
The requested estimates are; (Fees include 4% Technology Fee)
❑ VESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; $0 fee
X VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208; $294.32 fee required
❑ Subdivision (roads, drainage, etc.) per Subdivision Ordinance section 14-435;
& Water & Sewer per Subdivision Ordinance section 14-435; $307.84 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
EMAIL: Yl „1 - (:�? Gee fi Iv ooC o(s
OR REGULAR MAIL ADDRESS:
Revised 7/1/21