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Home My WebLink AboutWPO201500014 Application 2015-03-09 Albemarle a !"`OU f Community Development22902-Department r !'! i,.. 4011 re Road Charlottesville,V 22902-4598 '. ' *ow ;tee:(434)296-5832 Fax:(434)972-4126 ..,.P Planning Application PARCEL/ OWNER INFORMATION TMP 056A1-01-00-11800 Owner(s): LUCAS, MATTHEW Application# WPO2OI500014 PROPERTY INFORMATION Legal Description I ACREAGE # •r Magisterial Dist.I White Hall __...e7I Land Use Primary Residential-- Single-family(incl. modular home Current AFD : Not in ALF District Current Zoning Primary: R2 Residential 0 APPLICATION INFORMATION Street Address 1278 CROZET AVE CROZET, 22932Entered By ;anielle Roth:I] Application Type L Water Protection Ordinances Project 1278 Crozet Ave- VESCP Received Date 03/06/15 Received Date Final Submittal Date Total Fees 150 Closing File Date Submittal Date Final Total Paid 150 Revision Number Comments Legal Ad h SUB APPLICATION(s) Type Sub Applicatio Comment Erosion and Sediment Control Plan . APPLICANT /CONTACT INFORMATION ContactType Name .`address CityState Zip Phone PhoneCell Owner/ rt LUCAS,MATTHEW P 0 BOX 189 FREE UNION VA 22940 P'nrsry Cutlet `MATTHEW LUCAS 'PO BOX 189 'FREE UNION.VA 7036223522 Signature of ContractororAuthorized Agent Date *.r `r' 1 8A, Virginia Erosion and Sediment Control Program (VESCP) for Albemarle County ; J �. Mow (This application is only to be used for projects exempt from the Virginia Stormwater Management Program,VSMP,and the DEQ General Permit) Project Name: 1278 Crozet Avenue, Crozet Ave (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No RI 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 17-401]. 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. 56 al - 1 - 118 matthew lucas 3/6/15 Tax Map&Parcel Print Name of Property Owner gnatur wner 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Matthew Lucas Address PO BOX 189 City Free Union State va Zip 22940 Daytime Phone(703) 622-3522 E-mail mlucas@telestrategies.com B. All Fees [Code section l r 207] Total acres proposed to be disturbed 0.001 Acres to be disturbed Total Fee Less than 1 $150 per review More than l $300 per review For amendments to an approved plan;$200 per review Variances;$150(per request) Exceptions; $240 Mitigation Plan;$150 Construction Record Drawing;$300 ❑ C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ E. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ F. 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 Matthew Lucas Address PO BOX 189 Cit}, Free UNion State VA Zip 22940 Daytime Phone(703) 622-3522 E-mail mlucas@telestrategies.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# Fee Amount$1 Sb•a a Date Paid 31 is)i‘ By who? M 4-.1' crJ Receipt# C 01�o Ck# 2-9 2-L1 By: pg 2-u4-05 COUNTY OF ALBEMARLE °W®e.m Department of Community Development A401 McIntire Road Charlottesville,Virginia 22902 VSMP Application Completeness Check Project Title:Id?" 6 : -I f j ,. -v t :„ File Number: i.)..)Vbt Date: 4.-, Reviewer: Your application has been checked for completeness per section 17-409 of the County Code. All items must be received and correct for the application to be deemed complete. ❑ This application is complete and plan review has begun ❑ This application is not complete. Please provide the missing items checked below. Received Correct Y N Y N N/A V'❑ Completed application 0 0 0 �%❑ Signatures of the Property Owners for each parcel affected ❑ ❑ ❑ [�' ❑ Correct Fees Paid 0 0 0 - ❑ —❑ Registration Statement on the official DEQ form, with correct LDA 0 0 0 iD ❑ Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ ❑ ❑ ❑ ❑ Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ ❑ ❑ ❑ ❑ Pollution Prevention Plan satisfying the requirements of code section 17-404. The EPA template should be used. ❑ ❑ ❑ ❑ ❑ Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. The EPA template should be used. ❑ ❑ ❑ ❑ 0 Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ ❑ ❑ ❑ ❑ Requested Variations or Exceptions as provided in code sections 17-407 and 408, if applicable. (SSF,MMT, etc) 0 0 ❑ ❑ 0 Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. ❑ ❑ 0 Comments: ■