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WPO201400091 Application 2014-10-29
Albemarle Co,,,elity Community Development Department 417,61clntire Road Charlottesville,VA 22902-4596 Planning Application Voice:(434)296-5832 Fax:(434)972-4126 PARCEL/ OWNER INFORMATION TMPI 07800-00-00-05800 Owner(s): Application # WP0201400091 RIVERSIDE VILLAGE PROPERTIES INC PROPERTY INFORMATION Legal Description ACREAGE Magisterial Dist. Rivanna Land Use Primary Forest Current AFD Not in A/F District Current Zoning Primary Neighborhood Model District APPLICATION INFORMATION Street Address Entered By Application Type Water Protection Ordinances Todd Shifflett 110/29/2014 Project (Riverside Village Received Date 10/27/14 Received Date Final Submittal Date Total Fees 200 Closing File Date Submittal Date Final Total Paid 200 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicati ( Comment Erosion and Sediment Control Plan Stormwater Management/BMP Plan 'APPLICANT/ CONTACT INFORMATION ContactType Name I Address CityState Zip Phone PhoneCell Owner/Applicant RIVER5IQE VILLAGE INC 200 GARRET(`ST STE S CHARLOTTESVILL 122902 Primary SHIMP ENGINEERING 29__._...,._.....43.: nma Contact 201 E. MAIN ST,SUITE M CHARLOTTESVILL :22902 4342078086 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) ioc . ,gym Application for Albemarle County Project Name: Riverside Village (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 121 No ❑ Is this a revision or resubmission for review? Yes ❑ No WI County File Number: z` -00021 ty (to be provided by the County for new applications) 2a t4 The following are required elements of new applications[from code section 17-401]. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 78-58 Riverside Village Properties I 7 Tax Map&Parcel Print Name of Property Owner S _ atur• . Own Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Chris Henry Address 200 Garrett St, Suite P City Charlottesville State VA 22902 Zip Daytime Phone(434) 466-9426 E-mail chenry@pbmcap.com 7/1/14,Revised:7/10/14 Page 1 of 2 Fees paid directly to DEQ Prior to 7/1/2014. 1 1 B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 11.64 Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved pl.n;$200 per review Variances;$150 Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. DEQ Registration on File. V D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Shimp Engineering Address 201 E Main St, Suite M City Charlottesville State VA Zip 22902 Daytime Phone(434) 207-8086 Email justin@shimp-engineering.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$2 IX Date Paid)© 4y who?�� I Receipt#0 110 W Ck# 2-'I 23 By 1 l n L tinyWi 1 r6../ 7/1/14,Revised:7/10/14 Page 2 of 2