HomeMy WebLinkAboutWPO201500047 Preconstruction Form 2015-12-17 Request for Pre-construction Meeting and Grading Permit ,<4,13
from Albemarle County Ilt
Approved Plan Number: WPO- Z.0/5- - doOy7
Approved Plan Name: —Mc /3 n>IT e- 1 c Of"
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: 4/7//5
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: A4.i114n All U
State Certification Number: £2LD
Address 4223 1/9Sv/fie I
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City Q/ S h/4 g /ni4 State Y/ Zip 2293,c
Daytime Phone(y3 y ) '/6G -7�/Y E-mail nakdI'Tcr/re(&g/Yfd/t Coit
Primary Contractor:
Print Name 'Perri, Oa, 1rJin RnI LUYI Y Ok
Address V2-Z3 la1,14G /e
City 6(18.5 /IL State Of Zip 2213.6
Daytime Phone( ) �(p4"7// E-mail iQ/a r1err mu/. evoi
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
1 and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised:8/29/14 Page 1 of3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
bre" ad ,4nn ,darken Amite utt 4)►5 1
/va f! Phis Ph terra. WY- 44-goy
/*4 w' Crane. Pr/trrh '/3 y- 9$/ - '/96/
Chad /Gt,vS a+l i na oe. V.3Y -531 - /273
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 Page 2 of 3
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