HomeMy WebLinkAboutWPO201400068 Preconstruction Form 2015-01-20 0:w.,
Request for Pre-construction Meeting and Grading Permit
from Albemarle County ARC
Approved Plan Number: WPO- 24/il®p2g
Approved Plan Name:We.11i/67pA1 eX,v7k7 gad - 7W Z/(y.&' /7)je2,46ca#67/n
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: i I 0/ gD/�
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Dist rber: /
Print Name: ! L • VC- 6
State Certification Number: /0/190
Address (JJ'JO deal'/to/J -AV 1)/ti V•
City ('2/‘47A-blvl G66- State k Zip */
/ • 88OO E-mail L&'iJ l' V-67 ...1- 00007A/Gs. GDP/
Daytime Phone ) (D
Primary Contractor:/ ,/
Print Name V CArol l/JQ77 NG. LT 0 •
Address 2�3C7 ep,G1,GloAl L (4 a 'Vitt vg
City 04 ab 77 YI LL State VA Zip tZ. O 1
Daytime Phone( ') '5 , ' e,C. E-mail Vg V — 4V47/04 • Ld Al
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:
N."es(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