HomeMy WebLinkAboutWPO201500031 Application 2015-05-18 Albemarle Co' lty
2* 17
Planning Application
PARCEL / OWNER 'INFORMATION
l'•*; 05600-00-00-09400 WILSON JONES COMPANY JIM BEAM BRANDS CO
Application# WP0201500031
PROPERTY INFORMATION
ct ACREAGE
!•,!s; 3t. White Hall
_se Pr:rn:ar, Forest
current Ft Not in AjF District rrt Light Industry
'APPLICATION INFORMATION
Fir,tered St
I
an.alle Roth
Water Protection Ordinances
Pr :!' Wilson Jones Company - VSMP
105/13/15 Peta .at T5t-s'F 2700
F :sate ' T 2700.
-SUB APPLICATION(s)
Type 5:2;4p. tic C.,omfrent
Erosion and Sediment Control Plan
Stream Buffer Development Request
Stormwater Management/8MP Plan
APPLICANT / CONTACT INFORMATION
CcntactTip Name 4adress CivState Ztp f Fe Pit,;:47eCe.117
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Virginia Stormwater N ia ement Program (VSMP)
Application for Albemarle County
Project Name: t 150VA 15C Cell? 5 C G i\A (-1
(The name should be the same as it appears on plans) J
Is this an amendment to an approved plan? Yes ❑ NoX
Is this a revision or resubmission for review? Yes ❑ No
County File Number: (to be provided by the County for new applications)
The following are required elements of new applications `from code section 17-4011 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.
e00" C:,) Q
Tax Map& Parcel Print Name of Property Owner Signature of Owner D e
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 dllys 6 to /A/tic(7)(
Address 370 t/ p
City ,l!ef c t e j G� State ��Zip 6CG(,S
Daytime Phone( E-mail'-1�' \\. .SC)W. i`C)Y(Gt w1S U 44DCd•tCh
7/1/14, Revised: 7/10/14, 1/7/14 Page 1 of 2
le
❑ B. All Fees [Code section 17-208]
•
For new or modified plans; Total acres proposed to be disturbed • O aCreS
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.
NA H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
N \ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
NI X 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 J A r\ T. \GILT e vt-* ec1 A6 11\
il
Address d U torkL,ects1 }i�; 5 c�
City r-t 41 e,,,{e State 0 /1-1 ZipJ U �L C�
Daytime Phone(L/U j) 30/C/. 900C) E-mail TCAAuA_E-� ��z+� f L Qom? LA,1. 1 e- . cc.wyl
*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 0:7 o 9eo Date Paid 5-43_LS By who? 41-10v1) \ Vsra onol q keceipt# 61191 SL Ck# 11 By: Asa_
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