HomeMy WebLinkAboutWPO202300019 Application 2023-03-21Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
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Project Name: 5th Street Landing 3elfStorage
(The name s.iould be the same as it appears on plans)
Is this an amendment, modification, or transfer of an approved plan? Yes a No ❑
Is this a resubmission for revi,.w? Yes ❑ No la
County File Number: WPO-_ (to be provided by the County for new applications)
The following are required elen: ents of new applications [§17-401]. For amendments and resubntissions,
please indicate which items are being amended. Signatures must be provided for any submission.
❑ A. Signature of the Owner 1 or each parcel: (Required with every submission, NOT TO BE SIGNED BY
AN AGENT OR CONSULTANT)
By signing this application .is 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 thi- County of Albemarle the right to enter upon the property as required to ensure
compliance with the approv ed plans and permits.
76-55A FTVIVESTMENTS LLC �E 1 /IiULl 3P Z6Z
Tax Map & Parcel Print Name of Owner Signature o wner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Cw`ner(s) to receive correspondence:
Print Name: '<q �101G / fS�N t/Y1d
Address: 3 G I en O a s i�� �1.6 1,_,fJ
city: c_�or1bJ+'e- o` e
DaytimePhone:(t3�� — JS E-mail: ` lJ !
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❑ B. All Fees [Code § 17-208]
For new or modifiedplans: Total acres proposed to be disturbed 128
Fee Due with this
Transfer or
Acres to be Disturb .d
Application
Modification Fee
Total Fee = (Application Fee + 4% Technology Surcharge)
Single Family Dwelling only
$171.60
$23.92
Less than 1 acre
($165 + $6.60)
$23 + $0.92)
Single Family Dwelling only
$171.60
$236.08
1 and less than 5 acres
($165 + $6.60)
($227 + $9.08)
Less than 1 acre
$171.60
$20.80
($165 + $6.60)
($20 + $0.80)
1 and less than 5 acres
$1,591.20
$236.08
($1,530+$61.20)
($227+$9.08)
5 and less than 10 acr(:s
$2,004.08
$294.32
($1,927 + $77.08)
($283+$11.32)
10 and less than 50 acres
$2,652.00
$353.60
$2,550+$102
$340+$13.60
50 and less than 100 acres
$3,596.32
$530.40
($3,458 + $138.32)
($510 + $20.40)
00 acres or more
$5,657.60
$824.72
($5,440 + $217.60)
($793 + $31.72)
❑ C. Amendments to an apprc ved plan. Fee = $236.08 per review ($227 fee + $9.08 technology surcharge)
❑ D. Registration Statement o a the official DEQ form.
❑ E. Erosion and Sediment Control Plan satisfying the requirements of Code § 17-402.
❑ F. Stormwater Managemen : Plan satisfying the requirements of Code § 17-403.
❑ G. Pollution Prevention Plan satisfying the requirements of Code § 17-404.
❑ H. Stormwater Pollution Prevention Plan satisfying the requirements of Code § 17-405.
❑ I. Mitigation Plan satisfying the requirements of Code § 17-406 for any proposed disturbance of
stream buffers. $176.80 (1d70 fee + $6.80 technology surcharge)
❑ J. Requested Variations or 3Xceptions as provided in Code §17-407 and §17-408. $176.80 ($170 fee +$6.80
technology surcharge)
Provide 2 copies of all plans an(i any supporting documents or submit all documents online. Professional
seals must have original signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant, or agent):
Name (Print): Chris Marshall, :ihimp Engineering, PC
Address: 912 E High St
City: Charlottesville
Daytime Phone: 434-227-5140
VA
E-mail: chris@shimp-engineering.com
22902
* When applications and plans are r viewed, 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 val id. Active permits are subject to annual maintenance fees [§ 17-2081,
FOR OFFICE USE ONLY WPO #
Fee Amount $ Date Paid _By who? Receipt # Ck# By: