HomeMy WebLinkAboutWPO201400061 Preconstruction Form 2014-12-09 vrr° \rr \ 17 kf.
Request for Pre-construction Meeting and Grading Permit
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from Albemarle County
Approved Plan Number: WPO- Z40/`f
Approved Plan Name: ` iS AJ21
(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:
Print Name: D 0 V/. 1 1914,, .I 7�E
State Certification Number: 7 //
Address 'j1, /� , ,
City C— State P:051 Zip :324/32—
Daytime Phone('in 91e- 4178. E-mail /V/L 5-7-14
Primary Contractor:
Print Name / j pcc J En r's'f"
Address J 1( cj'
City State Zip
Daytime Phone( ) E-mail
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 Fe eat 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
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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 Date
By who?
7/1/14,Revised: 8/29/14 Page 2 of 3