HomeMy WebLinkAboutWPO201500025 Preconstruction Form 2015-10-05 NNW
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Request for Pre-construction Meeting and Grading Permit a otc,_
from Albemarle County J
Approved Plan Number: WPO- a�C/S + •
Approved Plan Name: C m 4 Pro per- t66 -- V5 m P Pte vi
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to a pre-construction meeting or permit)
Responsible Land Disturber:
Print Name: ��e �I1��1n Wade_ kiav,S
State Certification Number: \'l TC\Ct
Address 'J1 Sat5 \,,(.1n e—
City
City -odcx. State U 4 Zip .2,27
Daytime Phone(51D) 7 1 a 3 u 1 E-mail
Primary Contractor: \�'
Print Name ea.vtr WdwL5 Re-
Address L\Ock tc�eke W ODU-. GC.\Oq`
City �1 d.•,S I State VA Zip 22 727
Daytime Phone( iO) cl`\% `V1-LV C*G- E-mail VJ, rU;( Y\f,S zo►\ ,
(5-w) r.- % - t z o
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to he disturbed is contained on the approved plan and application.
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.86\ev‘.0a1(
and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised. 8/29/14 Page 1 of3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
\t\.\,ecLvE r nc- 540 - 1.)-00
Weaver 1•101..\(,c, (gq0)
\.N1 0-cLue 0- L S - F
\-1\ecvm.*11 (RLb \1\\,eave: \fA , N14„e-. st-to)
-beAot-o- tax\- C,c'(\ Vro (sq0) zi - 099 The second second part of the application fee is required to be paid with this request. This fee amount is; I-11 A
FOR OFFICE USE ONLY Permit Issued Date
By who?
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7/1/14, Revised 8/29/14 Page 2 of 3