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Home My WebLink AboutWPO201400075 Application 2014-08-27 - + ii(� ,, Albemarle CoL ty Community Development Department 401 , .,,Intire Road Charlottesville,VA 22902-4596 - Planning Application Voice:(434)296-5832 Fax:(434)972-4126 (PARCEL/ OWNER INFORMATION TMP! 06200-00-00-071A0 I Owner(s): TUERK, ADRIANA K, TRUSTEE OF THE ADRIANA K TUERK Application # I WP0201400075 I LIVING TRUST PROPERTY INFORMATION Legal Description !ACREAGE 1 B Magisterial Dist. Rivanna Land Use Primary Forest I Current AFD Not in A/F District Current Zoning Primary Rural Areas 'APPLICATION INFORMATION Street Address I I Entered By Application Type Water Protection Ordinances Todd Shifflett Project (Rocky Hollow 108/27/2014 I Received Date 08/27/14 Received Date Final I I Submittal Date Total Fees 300 Closing File Date Submittal Date Final Total Paid 300 Revision Number Comments Legal Ad SUB APPLICATION(s) Type I Sub Applicati Erosion and Sediment.Control Plan .: . ,,.. 'APPLICANT/ CONTACT INFORMATION ContactType I NameAddress � � I Phone PhoneCell Owner/Applicant. . TUERK,:ADRIANA K,'TRUSTEE OF THE A""i P 0 BOX 85 CityState Zip 36 Primary Contact JUSTIN SHIMP, P.E. 201 E. MAIN ST.SUITE M CHARLOTTESVILL 22902 4342078086 Signature of Contractor or Authorized Agent Date 'tare of\LRn Virginia Erosion and Sediment Control Program (VESCP) Application for Albemarle County Atrier. (This application is only to be used for projects exempt from the Virginia ""`'0 Stormwater Management Program,VSMP,and the DEQ General Permit) Project Name: "QC �l O)l Ul� (The name should belie same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No [X Is this a revision or resubmission for review? Yes 0 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. c4 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. L02-7 lig A-De3M-01- 1 v c •, _►_ • r8 2s.)t1/44 Tax Map&Parcel Print Name of Property Owner Signature of g � �.� 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 A ci°'r& To ark Address V.Q. 61- S City TSIamaCadti State FL Zip 33036 Daytime Phone( ) E-mail QO`►f I 1A..h) L e cut.Cavy, 7/1/14,Revised:7/10/14 Page 1 of2 Nome I t t3. All Fees [Code section 17-207] Total acres proposed to be disturbed 1 •CI Acres to be disturbed Total Fee Less than 1 $150 per review More than 1 $300 per review it'yi��.06 For amendments to an approved plan;$200 per review �" Exceptions;$240 Mitigation Plan;$150 Construction Record Drawing;$300 Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name v sr Iwi e E. Address 20( E. if)-?-7;10 scih V. City Chardulksviijt State 1/A Zip 22-(102- Daytime 2_(1V2-Daytime Phone(43 2 01 -Qb g'l'j E-mail )u 6‘c.i r € S wi , Er�,t J h e Can' yIC. *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ 34)&41° Date Paid C) 7)I'By who? / 1 C ( Iqr t Receipt#`f J CP (09 o y Ck# 252 ! By: k Toef� 7/1/14,Revised:7/10/14 Page 2 of 2 .40 • Virginia Stormwater Management Program (VSMP) Application for Albemarle County �4l; VL1K \ \Ut((0v..) �,ric�Ntr Project Name: (The name sh uld be the sai as it appears on plans) Is this an amendment to an approved plan? Yes 0 No Okr Is this a revision or resubmission for review? Yes 0 No it County File Number:\1P)?ply -7 c (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. M.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. Tax Map&Parcel Print Name of Property Owner Signature of Owner MI6 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 Address City State Zip Daytime Phone( ) E-mail 7/1/14,Revised:7/10/14 Page 1 of 2 Name X13. All Fees [Code section 17-208] " 1 For new or modified plans;Total acres proposed to be disturbed I . 1 610ep 'c 4rlt 1] �V1UW1Q- 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(4,^ 1 $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 $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. Pa D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. IX E. Stormwater Management Plan satisfying the requirements of code section 17-403. IX F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. X.H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. 0 I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Address City State Zip Daytime Phone( ) E-mail *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By 7/1/14,Revised:7/10/14 Page 2 of2 Virginia Stormwater Management Program (VSMP) Y ` ' fait w 4 Application for Albemarle County 4:' , e 1740 si Project Name: ki t bt") (The name should be the same us it appears on plans) Is this an amendment to an approved plan? Yes 0 No Er— is this a revision or resubmission for review? Yes'No 0 County File Number: VVPD2. l'1 Ob}c, (to be provided by the Coun(rfur new applications) TheJollowing are required elements q.new applications[from code section 17-401J. For revisions or amendments,please indicate which items are being amended. Signatures must be providedIbr•ant' 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 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. Tax Map&Parcel Print Name of Property Owner Signature of Owner Trate 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 lntbrmation for the Owner(s)to receive correspondence: Print Name Adri car1a I U erk Address ?Q .50k. $5 City J.51'� State FL Zip 3 Daytime Phone( ) I;-mail acir 1arL-toes_- ( a.o 7/1/14,Revised:7/10/14 Page 1 of 2 • 0 B. All Fees[Code section 17-208] 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 Application modification of permit _ Less than I $290 $145 $20 I and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,701) $250 10 and less than 50 $4.500 $2,250 $300 50 and less than S6.100 53.0.50 S450 100 100 and more $9,600 54,1(00 $701) For(minor)amendments to an approved plan:$200 per review Variances;$150 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. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers, ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ 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 docttn+ents. 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 (TuS+11/k c) tttrt19 Address 94)1 e. man a,. 5 G. lvt City CherIOI-4eSVI I (e State VA Zip.- 22g02 Daytime Phone(434 9°53" (p l 1(a E-mail j aJS{"t Y t @ `611(, -ery neer I p •C. "^ *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 SPO# Fee Amount S __Date Paid By t+ho? Receipt»__ C L# mY 7/1/I4.Revised:7/10/14 Page 2 of 2