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Home My WebLink AboutWPO201600026 Application 2016-04-14 Albemarle 'ounty .. . : _ „...- Road CharlottesvilleVA 22902-4CommunityDevelopment Departa 401 McIntire , ! Voice :(434)296-5832 Fax:(434)972-4 Planning Application PARCEL J OWNER INFORMATION TMP 09400-00-00-015A0 Owner(s): HICKS, HARRY 3 III&NANCY L Application # WP0201600026 PROPERTY INFORMATION Legal Description I ACREAGE PARCEL W Magisterial Dist. Scottsville . Land Use Primary Unassigned Current AFD ; Not in A/F District , Current Zoning Primary , Rural Areas [APPLICATION INFORMATION Entered Street Address — , Judy Martin Application Type I Water Protection Ordinances . i 4/14/2016 Project The Hicks Residence-VSMP Received Date 04/12/16 Received Date Final Submittal Date 04/25/16 Total Fees 2 Closing File Date Submittal Date Final Total Paid 2 Revision Number Comments COVERS BUILDING PERMITS B201600719/B2.01600720 AND B201600721 Legal Ad SUB APPLICATION(s) Type Sub Application Comment Erosion and Sediment Control Plan 04/25/16 Stornawater Managetnent/BP4P Plan 04/25/16 APPLICANT/ CONTACT INFORMATION ContactType j Name Address CityState I Zip Phone PhoneCt Owner/Applicant HICKS, HARRY 3 III&NANCY L 7793 SOLITUDE CT MCLEAN VA 22102 . . Primary Contact JUSTIN SHIMP 201 E. MAIN ST. STE. M CHARLOTTESVILL 22902 4342275140 mmillimmimmmammmimm Signature of Contractor or Authorized Agent Date t Virginia Stormwater Management Program (VSMP) Application for Albemarle County Project Name: E�. :, �;. t► •,1 (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No 6 Is this a revision or resubmission for review? Yes Cl No LSF County File Number: WO 4016.2 '(SQ (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 he provided for any submission. 0 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 compiled with,and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albcmnrte the right to enter upon the property as required to ensure compliance with the approved plans and permits. 4 -- 15 A 14 10: &kid 'fax Map&Parcel Print N of Property Owner Signature of Owner Date M v 1- hid/ .l X4I'r Vi 4 Tax Map&Parcel Print NantFofProperty Owner Signature of Owner Date Tax Map&1'nrcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Numc of Property Owner Signature of Owner Date Contact Information fortheOwner(s)to receive correspondence: Print Name 4 L/ Address 771:111;b44_ City_ Zia State V Zip Wall Daytime Phone(d f/f OPV E-mail 4 1. Pr/Ger, V ff 4s,�.4,.....C•s+' 7/1/14,Revised:7/10/14, 1/7114 Page 1 of 2 • Sii c— l - ❑ B. All Fees [Code section 17-2081 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 tion modification of permit Less than l $290 $145 $20 1 and less than 5 $2,700 31, 50 $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;$150 O C. Registration Statement on the official DEQ form. C'D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 121E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals muss have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondencerre (usually the plan preparer,consultant or agent) Print Name �.l 1-1S+lex s 1 i p Address eaL e7 j E NI/l T'N S`C-(zee_1 s U f —(1 city C avty.f-{-mssvi State VA Zip r.-2 q0.� Daytime Phone(Oat) z7- -fit to E-mail r �_ ► - - I YU. COQ *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# VVQ Fix Amount$ Date Paid la ll By who? \T M1 1' Receipt#10 1403 t Ck# `/W 11 By: �J 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2