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Home My WebLink AboutWPO201500106 Application 2015-12-21 Community DevelopmentDepartment T Albemarle County 401 Mclntirm 4nad Charlottesvills.VA22902-4516 Voice 4)296-5832 Fax:(434)972-4125 --- za" Planning Application Nkine Neve PARCEL/ OWNER INFORMATION TMP 06201-OO-O0-OO100 Owner(s): KEY WEST CLUB I Application# WPO2OI 5001016 PROPERTY INFORMATION Legal Description I KEY WEST s, Magisterial Dist.i Rivanna '► Land Use Primary Semi-public El Current AFD Not in A/F District E Current Zoning Primary` Rural Areas [APPLICATION INFORMATION Street Address 393 KEY WEST DR CHARLOTTESVILLE,22911 Entered By Application Type i _........ .. . ..____._.__... _.. ......___ - Etni y Lantz + PR yp Water Protection Ordinances 112/2112015 Project Dunlora Interconnect-VSMP Received Date 12/21/15 Received Date Final Submittal Date Total Fees 1350 Closing File Date Submittal Date Final Total Paid 1350 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicatio Comment Stormwater Management/BMP Plan • Stream Buffer Mitigation Plan Erosion and Sediment Control Plan APPLICANT /CONTACT INFORMATION ContactT Name Address Ci State Zi Phone PhoneCell owneriApprcant KEY WEST CLUB I i 393 KEY WEST DRIVE CHARLOTTESVILL 22911- arimary Cz,rta t CHIP VOTAVA 272 BENDIX RD SUITE 400 pVIRGINIA BEACH 23452 7576315404 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program SMP arta Application for Albemarle County 161 ;t Project Name: Dunlora Interconnect (Project No. 2010-06) (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No LI Is this a revision or resubmission for review? Yes ❑ No 0 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. 062F0-00-00-000A3 Club Dunlora, LLC (easement being aquired) Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 062B1-00-00-00100 Key West Club 1 (easement being aquired) 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 Albemarle County Service Authority (do Michael Vieira, PE) Address 168 Spotnap Rd City Charlottesville State VA Zip 22911 Daytime Phone(434) 977-4511 E-mail mvieira@serviceauthority.org 7/1/14,Revised: 7/10/14 Page 1 of 2 ‘011111e 'WO" ❑ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 3.96 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 $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;$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Michael Baker International, Inc (do Chip Votava, PE) Address 272 Bendix Rd., Suite 400 City Virginia Beach State VA Zip 23452 Daytime Phone(757) 631-5404 E-mail cvotava@mbakerintl.corn *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ ISSO.oa Date Paid/2.111/1C By who? U b Orb/ Receipt# la 2C:71 Ck# 4 peg lS By: Da. -- 7/1/14,Revised: 7/10/14 Page 2 oft