HomeMy WebLinkAboutWPO201400074 Preconstruction Form 2015-02-18 r
Request for Pre-construction Meeting and Grading Permit
from Albemarle County ,_
Approved Plan Number: WPO- Zv i cf O00 7'1
Approved Plan Name: WPC) f/4, �� a, ' U,,'/,j z .. f'L ' f!'
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: 2/ l$/2 015
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Dis turber:
Print Name: L>69j,,,,.a,,,‘ k c- ve/1 ,n LI-C_
State Certification Number: 3/, 773 J
Address 29 71f 1 e "J r
5S�
City „„pc,5) State VA- Zip 2-3 o.2
Daytime Phone(SYU) - 33L/Z E-mail ova W.,A,n e - ;Y:y +f Q1601%10,(:W%
Primary Contractor: �l
Print Name v t n.61„� �,<c�r�i/u ,, /Lc
Address 247
City r,.i ie.S S State I4,4 Zip 73 02-y
Daytime Phone(9/0) *'/ - 3 3Y2,. E-mail c .?rJ p, , 5 741cC).(
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan a icah :
VS I':
Acres to be 41 'ed ue at Grading Permit V `
Less than 1 $63.80
1 and less than 5 � $594.00
5 and less than 10
10 and less tha . $990.00
50 and le an 100 $1,342.00
100 d 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
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Person(s)to attend the Pre-construction Meetjng:
Names(type or print) Firm
_ Contact Numb er
or email
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V �'1 "i b�" +�/ �0 ,�c1t l)'e� )� ��I�/� S� l�' at f8"7 cep. ('.Ct-,
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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 Pay