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Home My WebLink AboutWPO201500029 Application 2015-05-18 Community Development Department tliCi Albemarle Couni-i, 401 t ire P Charlottesville,VA 22902-4598 w 296-5832 Fax:(434)972-4126 lo Planning Application Ivasse 'Noe • PARCEL7 OWNER INFORMATION IMP 076M1-00-00-002A0 Own e r(s): 5TH STREET STATION VENTURES LLC Application# WP0201500029 PROPERTY INFORMATION Legal Description ACREAGE Magisterial Dist, Scottsville Land Use Primary Forest Current LFD Not in A/F District E Current Zoning Primary Planned Development Shopping Center APPLICATION INFORMATION Street L.Jdress I Entered By Emily Lantz Application Tpe Water Protection Ordinances Project 5th St. Station Phase II Amendment II Field Mod Received Date 05/13/15 Received Date Final Submittal Date Total Fees 200 Closing File Date Submittal Date Final Total Paid 200 Re,ision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicant) Comment _ Stream Buffer Mitigation Plan Erosion and Sediment Control Plan Stormwater Management/BMP Plan APPLICANT / CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhoneCell Lt. 5TH STREET STATION VENTURES LLC 5 WEST BROAD STREET STE B FAIRBURN GA 30213 DANIEL HINES 28 BLACKWELL PARK LANE WARRENTON VA :20186 5403494500 Signature of Contractor or Authorized Agent Date Now' 'verge NNW Nurse Virginia Stormwater Management Program (VSMP) : 14 -� Application for Albemarle County w � Project Name: 5th Street Station - Phase II Amendment II Field Modification (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ICI No 0 Is this a revision or resubmission for review? Yes 0 No I>� County File Number: WPO2013-00079 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401.1. 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. 76M 1-2B Codo S 5/13/15 Tax Map&Parcel Print tine of Property Owner igna of Owner Date 76M1-2A ��a Co if oks 5/13/15 Tax Map&Parcel Print sine of Property Owner igna of Owner Date 76M1-4A �i�� avi sd/.S j-''' 5/13/15 Tax Map&Parcel Print of Property Owner igna of Owner Date 7700-11 E 1 5/13/15 Tax Map&Parcel Print ame of Property Owner i o�xJ gna of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Stephen Collins Address 5 West Broad Street, Suite B City Fairburn state GA Zip 30213 Daytime Phone(770)692-8300 E-mail steve @sjcollinsent.com 7/1/14,Revised:7/10/14,1/7/14 Page 1 of 2 *WOW 'VOW ❑B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 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 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150(per request) Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. ® 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 plant 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 Daniel R. Hines, P.E., Bohler Engineering Address 28 Blackwell Park Lane, Suite 201, City Warrenton State VA zip 20186 Daytime new(540)349-4500 E-mail dhines @bohlereng.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# /�(�n �f� Foe Amount�U) Date Paida By who? 10.E 411l..�t. ca 1# Rooeipt#qq q44, Q 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2