HomeMy WebLinkAboutWPO201600038 Application 2016-07-05Virginia Stormwater Management Program (VSMP) y
Application for Albemarle County1;
Project Name: Crozet Business Office
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 10
Is this a revision or resubmission for review? Yes ® No ❑
County File Number: WP0201600038 (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.
05500-00-00-11000 Clyde Simmons
Tax Map & Parcel Print Name of Property Owner
Signature of Owner
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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 Clyde Simmons
Address 6181 Rockfish Gap Turnpike
City Crozet State VA Zip 23932
Daytime Phone 4( 34) 823-5154 E-mail csimmons@FandR.com
7/1/14, Revised: 7/10/14, 1/7/14 Page 1 of 2
W1 B. All Fees [Code section 17-208]
Ell
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than 10
$33,400
$1 ,700
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than 100
$6,100
$3,050
$450
100 and more
$9,600
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
Z D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
FZ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
10 F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
W1 G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
21 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
El 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
El J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 eopies of allplans and any supporting doeuments. Professional seals must have original
signatures.
Additional information if not provided on plans and documenti
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*When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 montim
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid. I
FOR OFFICE USE ONLY WPO #
Fee Amount $ Date Paid -By who? Receipt # Ck-# By:
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