HomeMy WebLinkAboutWPO202200002 Preconstruction Form 2023-03-22ix Ai
Request for Pre -construction Meeting and Grading Permit -+ '_
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from Albemarle County — VSMP ,;. ` ..,.
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Approved Plan Number: WPO- 202-2-00002 DEQ Permit # (if applicable): VAR10- C'60 b
Approved Plan Name: N6 r-i'ti I%1 'ta. S e c-'Ae...--. Z
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: Z l 21 % Z3
(Bonds must be approved and posted prtor to a pre -construction meeting or permit.)
Responsible Land Disturber: [�
Print Name: DrW `)
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State RLD Number: aL D M 0 0 Q
Address:
City:
State: Vk Zip: ZZ fO I
Daytime Phone: 69q sbD gZ�� E-mail: tj 4V1O� 507 ua5$t G .
Primary Contractor:
Print Name: CUI/ I (S 60,•s:
Address:
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City: (I jes4 PO1�+ State:V✓1— Zip: Z3
Daytime Phone: O$) � yq E-mail �. e� 1�� G UJ 1 15 Cfiv1 l�tr
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Permit Issuance Fees (Request must include payment) [Code §17-708]:
Total acres proposed to be disturbed as shown on the approved plan and application: o17.4JY Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
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+
50 and less than 100 acres
1,58 .84
$1,521 + $60.84
100 acres and more
,
$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/l/2021, 7/26/2021, 9/15/2021 Page 1 oO
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/l/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/26/2021, 9/15/2021 Page 2 of