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HomeMy WebLinkAboutWPO201400104 Preconstruction Form 2014-11-21 Request for Pre-construction Meeting and Grading Permit "cc from Albemarle County . Approved Plan Number: WPO- 2°' 4 o o t o '( Approved Plan Name: 4 l� r e_ Sc L06( 6.-Cf‘ �,,� 44;41 A, c .‘ (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: ttr(xs State Certification Number: 2-9"G 6 G 3 t 8 tf Address (N0 GeV 3 ( City Cir L47"4c-.t'4,4. LL.c. State LA Zip 1--Z-41.47Z Daytime Phone((7Y) 4 - YY Jl' E-mail if r`{-4-6-4 E.", r/.c.c o n. Primary Contractor:�y( Print Name Ac'- - Q,i. �.S�Cvc ✓e,. 1 ��e. Address t (3 Z /(-\-4 City d o Sv,(,Ce State VA Zip Z 2-(tee? Daytime Phone(LC1C) S t7 '1 E-mail .1 0l`^4't( Co Permit Issuance and First Year Maintenance Fees: (Request must include payment) Total acres proposed to be disturbed is contained on the approved plan and application: VSMP: Acres to be disturbed Fee Due at Grading Permit Less than 1 $63.80 1 and less than 5 $594.00 5 and less than l0 $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 of 3 Person(s)to attend the Pre-construction Meeting: Names(type or print) Firm { puMtiContact Number or email Jo �/��4/t /4-P �,.rAra 7J gy1t t c � vb Vr s.cy.4 Al t-C /4r�J ck.. p 9©.3 /78 2&?E v 1,s te' a►r` ' 131`0sic La•oD 2-6(f tjro•k e d91 .tnc co,0%. The second part of the application fee is required to be paid with this request. This fee amount is; FOR OFFICE USE ONLY Permit Issued Date By who? 7/1/14,Revised:8/29/14 Page 2 of 3