HomeMy WebLinkAboutWPO201600011 Preconstruction Form 2016-06-20 Fre- co-A
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Request tar Pre-constru In Meeting and Grading Peru f �a
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from Albemarle County Ly l6
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10:
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Approved Plan Number: WPO- Q\ V r ( COO 1 (
Approved Plan Name: 's/S NI t' PLAN . .or HAPVST '" I00IJ - 1 -jAs - I
(Plans must be approved prior to a pre-construction meeting.)(
Bond approved date: V A 0 1 1 t7
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: EPOO.D L •
bDNA 14 c41/41_
State Certification Number: PE, #- 0+0,A00519/7
Address 3451i po KTo$A Gi o /
City f;8T— ___LLQ L' VA_ `J ---�,__State Zip — — —
Daytime Phone( 7a 3 134 E-mail DO A brb.1 CoN Co, (az ,L 1 Co tv
Primary Contractor:
Print Name >bQ1441-.S0t COIV JTKU,C-710 oi14 _ —
Address a- 6 N-rLift)/_�
City e C.L O ES\elt LL.a State VA zip 03
yt 7A17_3.1'3 4 E-mail ft A L 5 0 `�N:S (0 e oval-
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Daytime Phone -
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
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.
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Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
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.7E.Er- S1 m S (Y1 A&T i N RI)aA L) S t nASO riNk+,-V‘,v,Voir, m
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ac,;-1,0,--)i'11 A -V--- 1-N) 14 t-j'�?-v z- 1-110,:.%.Ci.f e:I t tt ti 'i LA Nil t a, Y\.ikAI VS 14A.\11 ti=)( r'rn.c `.Lt,A,-..
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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?