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HomeMy WebLinkAboutWPO201400061 Preconstruction Form 2014-12-09 vrr° \rr \ 17 kf. Request for Pre-construction Meeting and Grading Permit 9 g g J� ` 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 / efidGg7- 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