HomeMy WebLinkAboutWPO201300052 Preconstruction Form 2014-08-29 X05
Request for Pre-construction Meeting and Grading Permit te"® '
from Albemarle County f
Approved Plan Number: WPO- aQ 63 - 00 5 I
Approved Plan Name: Q6cr(rcti gicck l P ase_B cs.n o.,ck:3 . Phase c.
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(Plans must be approved prior to a pre-construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: 2 q
Print Name: SCe_.) �")Rhos��1\r'J A c1 D i I(U.✓�•4
State Certification Number: r 947-,('}
Address y !j 1vt e rw�C7,--y
City -1f0yr State VA Zip t{
Daytime Phone( )111 3150 E-mail �"c U i't: r . (0;1
Primary Contractor:
Print Name A6 616-g-b
Address C15 t4 ervv)rk j (.--A NI
City 1-I D 1 t State JA Zip `aDq✓r L
Daytime Phone( ) 91 1 - 315 0 E-mail p.A - ,)oq rt i U 0. . Co o
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 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
SCc,ft �f ,1S�IC��:� ACS D11(a 4:;r,,-l-t cadet, (Sct;r{1 . (cm
pt.11 Lerl 11z-tie R. 'c.pt At4c.ti(A.sh l?j;t I C. 11.'01A(Jr-C)L. 11 C v\--‘
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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 Dstc
By who?
7/1/14,Revised: 8/29/14 Page 2 of 3