HomeMy WebLinkAboutWPO201500033 Preconstruction Form 2015-12-04 pF 11.IjA
Request for Pre-construction Meeting and Grading Permit
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from Albemarle County
Approved Plan Number: WPO- 2,915-- 0000 33
Approved Plan Name: ���r�rook
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: I211-1 I1 S
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: a�S S ' ' Adncva�
State Certification Number: R-1--D 0 2 Si i-I 3
Address pv $oX aH
City CA 4rtiireCtSo61k State VA Zip -1A"-
Daytime
Daytime Phone(tl3►I) ' 5' E-mail j-S.50fedd;r Corn
Primary Contractor: kAi%Print Name PeW'\4"4v)
Address P O Box
City �j�GV o{tGs1114 State VA Zip 22-41 0.6
Daytime Phone(431) q145-- E-mail p-eke, e.ae'l'1workScYc4VA`-tea- -c_ovv
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 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 of 3
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Person(s)to attend the Pre-construction Meeting:
Names�m (type or print) Firm Contact Number or email
.J-ess 4 6Rt,t,. licot D,;,-k- I74....-(1.F40,4*S 4314- 2142- 1Sro2-
50StUt% SIltuip St')i h.u,,r N3H^ 553.- ro114
'17-ci-y. Wet .0,an �,, 4,4,o, 4 XCav¢ ti},V 13
, ' N — S31-5-96 S' �
r)^ 4G �
e4le ,. 1.74-/ - 2c► t,- ..CS- 3-2
\1\n ; 10lc A/'k? 4A i ('a. y3 y. 2-9 G • CP 3:2
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