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-- Planning Application
PARCEL .. OWNER INFORMATION
T''' ( 01500-00-00-01600 Ori'nersl: MAYBURY, KATHLEEN PATRICIA OR JOSEPH BRYANT CALHOUI
Application# WP0201600010
PROPERTY INFORMATION
LE 3a:Ges:ription i ACREAGE -_._..._.._._..�.,_,,._.,�,_, ___________......-•• •
magisterial Dist. White Hall � Land Use Primary Residential -- Mobile home .i
Cur,ent=FO Not in A/F District I•( Current Zoning primas Rural Areas w„1
;APPLICATION INFORMATION _.______
Street Address Entered By
4,pplication T,pe Water Protection Ordinances ` anlalle Roth n
_ 12`19':015
orae:( Doyies River Crossing - VESCP
Re;* .ed Date 102/19/16 j Pece'i,ed Date Fina[ Submittal Gate Total Fees 150
Closing F;:e Late I 1 Submittal Date Final! T,.tal Paid 150;
Re,isic•n (lumber •
:amments
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y
SUB APPLICATION(s)
Tii [Sub 40icatipi Comment
Erosion and Sediment Control Plan
APPLICANT / CONTACT INFORMATION
L.antactT•1Pe__ i
_.__.__. _....._.,....._.__ �.� Noma __1_.._. Address ....v .I CirfState up _1-_...Phone Phor:eCeiI
k_.. _ :2-1 ht�i ELIRi h..-THLEEN P-TFIC1- OR 131E N.a,:•kEFTELD ST .RLINGTON t•- :22_Y'
-o-, ---'a:t +,.!.-"i-+LEEii r•+=YBUP•,' 17,1E N ''AAKEFIELLi ST 4.RUtiGTON t%• =0? E12'20
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I
ion,,ture of Contractor or Authorized Agent Date
Virginia Erosion and Sediment Control Program (VESCP) }gr►'p
Application for Albemarle County 1111,
(This application is only to be used for projects exempt from the Virginia
Stormwater Management Program,VSMP,and the DEQ General Permit)
Project Name: 7t S Use i— Cc ���r rc} 5--3-74-• (3r,AA, 6,- To CH p).
(The name should he the same as it appears on plain)
Is this an amendment to an approved plan? Yes 0 No L
Is this a revision or resubmission for review? Yes El No 1;1"---
County File Number: (to he provided by the County for new applications)
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 he providedfor 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.
0150t,- Oi(cOO V'&-Ul( -C., Mi1kuit3IA. 1-1 ../Jt/
Tax Map&Parcel Print Name of Property Owner Sigivt/-4-171(1434-)of Owner k Date
Tax Map&Parcel Print Name o'tiProperty Owner Sig atur of O r 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 k t M VL Li
(.t. ' L1
Address ` 3 `� 1\) Ct e P E(e L! ra-�-
City L I IV isTtV State 1f ft Zip . .2O
Daytime Phone Mit c [ 3 o E-mail K61.--t h ct.j1 (L5 l 6. (G C), C 6./t1
7/1/14,Revised: 7/10/14 Page 1 oft
❑ B. All Fees [Code section 17-207]
Total acres proposed to be disturbed O.14 ( / 2 S '`s"(„c
Acres to be disturbed Total Fee
Less than 1 $150 per review
More than 1 $300 per review
For amendments to an approved plan; $200 per review
Exceptions;$240
Mitigation Plan;$150
Construction Record Drawing;$300
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) O Ulf�! .Ui , , `� ( (L-41
Print Name `r e.v
Address
City State Zip
Daytime Phone( ) E-mail
*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# L y�� \ _
Fee Amount$19).0 a Date Paid Z:1 V9)1(BIL
y who? A-�'�legcl 1 rlerte/Receipt# )0 3ZQ/ig,c'k# )(02-9_ By:p
0F ?be. (1.41 bbun
7/1/14,Revised:7/10/14 Page 2 of 2