HomeMy WebLinkAboutWPO201400090 Application 2014-10-14 i„�Cil A(fat
Albemarle Cot. n ty Community Development Department
401 McIntire Road Charlottesville,VA 22902-4596
Planning Application Voice: (434)296-5832 Fax:(434)972-4126
PARCEL/ OWNER INFORMATION
TMP O62B1-00-0C-00500 Owner(s):
Application # WP020I400090 ARBAUGH, JAMES E & EDITH M
PROPERTY INFORMATION
Legal Description KEY WEST 1 C 5
Magisterial Dist. Rivanna Land Use Primary Residential -- Single-family (incl. modular homes)
Current AFD Not in A/F District Current Zoning Primary Rural Areas
APPLICATION INFORMATION
Street Address 332 KEY WEST DR CHARLOTTESVILLE, 22911 Entered By
Danielle Roth
Application Type Water Protection Ordinances 10/14/2014
Project Key West Water Main Replacement Project-VESCP
Received Date 10/13/14 Received Date Final Submittal Date Total Fees 300
Closing File Date Submittal Date Final Total Paid 300
Revision Number
Comments
Legal Ad
SUB APPLICATION(s)
Type Sub Applicati Comment
Erosion and Sediment Control Plan
1APPLICANT/ CONTACT INFORMATION
ContactType Name E Address { CityState Zip Phone 1 PhoneCell
owner/Applicant _:ARBAUGHJAMES E&EDITH M :332 KEY WEST DRIVE CHARLOTTESVILL !22901-02
Primary Contact ALEXANDER J MORRISON, EIT(ACSA) 168 SPOTNAP ROAD CHARLOTTESVILL 22911 4349774511
Signature of Contractor or Authorized Agent Date
moo,:
Virginia Erosion and Sediment Control Program (VESCP) ,Y1
Application for Albemarle County
(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program,VSMP,and the DEQ General Permit)
Project Name: Key West Water Main Replacement Project(Project 2010-06)
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No ii
Is this a revision or resubmission for review? Yes ❑ No if
County File Number: (to be provided by the County for new applications)
The following are required elements of new applications`from code section 17-401 J. For revisions or
amendments,please indicate which items are being amended. Signatures must be provided for any
submission.
Wr 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
V compliance with the approved plans and permits.
SEE ATTACHED RECORDED EASEMENTS FOR THE PROJECT
Tax Map&Parcel Print Name of Property Owner Signature of Owner Date
•. -4..s.t.rK4^1-5 fik tutid 1. Morrison ( cs4) /€03/1W
Tax Map&Parcel Print Name of Property Owner Sign 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:Alexander J.Morrison,EIT(Albemarle County Service Authority)
Address: 168 Spotnap Road
City:Charlottesville State:Virginia Zip:22911 Daytime Phone: (434)977-4511 ext. 116
E-mail: aorrison( ,serviceauthority.org
7/1/14,Revised: 7/10/14 Page 1 of 2
Albemarle County
Service Authority
s ,,♦cam,
TRANSMITTAL FORM
TO: Albanar4 6eun1.t Dwc\ovana 4- (Elx3ii u ry DATE: /4//3frf
SUBJECT: Keti Wes*- — k s izt.v;c' )
The following items are being sent: XAttached ❑ Via Fax
❑ Copy of Letter ❑ Specifications ❑ Shop Drawings
X Plans ❑ Contract ❑ Other
XPlat ❑ Change Order
If enclosures are not as noted; kindly notify us immediately.
Copies Description
oa K� t►kak Waken in can R.910.u.men4 Pcojuk - 1)16»S
a s tlec k q u &. (loge o r c& 1
IQ Uyctal.e, (re od din clav-
V E SGP 4Allicoki a1)
Fee. Cluck.. pWIN/a41- 0C-t14 4 (II 300
XFor Approval ❑ Approved as Submitted ❑ Resubmit_Copies for Approval
❑ For Your Use ❑ Approved as Noted ❑ Submit Copies for Distribution
❑ As Request ❑ Returned for Corrections ❑ Return Corrected Prints
❑ For Review & Comment ❑ For Bids Due
❑ Prints Returned after ❑
Loan to Us
Remarks: Q)14.c.66 key 0'1 /4n /er 633 re ev„) der' con r+.15
insfr,�a.F-.`on . 77,4 Wm,* 4G.S /ready 6.an o414011 '(• /
y
Signed: /
168 Spotnap Road • Charlottesville, VA 22911 • Tel (434) 977-4511 • Fax (434) 979-0698
vvww.serviceauthority.org