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Home My WebLink AboutWPO201500021 Application 2015-04-07 CommunityDevelopmentDepartment 3Ft Albemarle County - „hl6clntireoadCherlottes+;�iiie,VA2l2-4ra96 �� 4000 Voice‘11")296-5 Fax:(434)972-4926 I , ' -:. PLanning Application PARCEL/OWNER INFORMATION TMP l 3{ it ' V:'ryy„ # Owner(s) 111 E,) HN�H 3WORIB4Pli i. ,f 13' _ Application , . .,ww�:. ... PROPERTY INFORMATION I Legal Description , .,. . magisterial Dist ,1Mi ia1i` Land Use Primary #Residentlai $-t igf±e- dn'� i'(Incl .iiiOilUla+F hors °il , Current AFD 7 i3t tPrimary tit lI;AC ris# ' *` Current Zoning 3 1 2ls. ' —.,lel, i APPLICATION INFORMATION rri Street Address 5724 ST GEORGE AVE CROZET,22932 Entered By : .atm pP YP i „ 1 rg'• : t zC'. , .� A IiratiQn T Q ,. n n moi- � � �a �' 4,".'"'s .... • . . . d'u Proct to Cr .A I 7€rt#'si*E"GI Mo Received Date D4/O"3fi'S Received Date Final Submittal Date t-,4).,0::40,1,':,, Total Fees 3 Closing File Date Submittal Date final Total Paid i Revision Number •a ,,.,V, °; Comments4 ' ;. Legal Ad a' g " SUB APPLICATION(s) .:� , ' 7. . .,-,,,,, ,..f:','' ' .' .< r.. -.,` .. ..,...1,._ ,,.... a::r �` .;: " �.r r.,t,a.•:.. > '; k °n�� ' J�_Cl9 - ,.. . . ,.5.: - Stream Buffer Mitigation Plan • ' Stormwater Management/BMP Plan Imi 4'8" "' "i a. 5 '•,_§"iw a 7'y a' r '1. ',, +,1� i z h 4- r , s xa*ii a�v.,74^rt4 i APPLICANT 1 CONTACT INFORMATION �g 7 * rte' r , :fie,, »''i,4 x 2 ,:-,?.,1,4_,,, >,A -ir r, 3p �ei, 3 m :. '1. d� za ter..;':1'4101:.:0•.:5k. ti' .i e ?•, a ''' 3 �± ! 4 .:.. li� ,., '9+. ;" .z'.. .id.� " ` �..�.:..` :.. ..;�,�:• m's. `;i; � ��'�.....xh� - �. ..^.-d, c. .�#.a�� .�,..:� z� m ......... .e Pnrnery Contact FRANK POHL 491 MCINTIRE RD ROOM 222 CHARLDTTESVILL 22902 43497245(11 S J3 Al i a Signature of Contractor or Authorized Agent Date ri f (411014 Lti, Virginia Stormwater Management Program SMP) Application for Albemarle County 3 µ Project Name: Crozet Avenue North Sidewalk Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No IZI Isthis a revision or resubmission for review? Yes ❑ No m ) County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011. 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. 3 Not Applicable VDOT Locally Administered Project 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date .1' Contact Information for the Owner(s)to receive correspondence: Print Name Frank Pohl- Project Manager Albemarle County Office of Facilities Development Address 401 McIntire Road, Room 222 to City Charlottesville State VA Zip 22902 Daytime Phone(434) 872-4501 E-mail fpohl@albemarle.org 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of2 y s III tir II B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 0.5 acres Acres to be Total Fee Fee Due with this Fee with Transfer or 5 disturbed Application modification of permit . Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 Albemarle County Proj. 5 and less than 10 $3,400 $1,700 $250 Fees are waived 1 10 and less than 50 $4,500 $2,250 $300 ij 50 and less than 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 =1 For(minor)amendments to an approved plan;$200 per review 1 Variances;$150(per request) Mitigation Plan;$150 ® C. Registration Statement on the official DEQ form. 0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ® G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A ❑ I.- Requested Variations or Exceptions as provided in code sections 17-407 and 408. N/A u ❑ J. Construction Record Drawings (as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. N/A Provide 2 copies of all plans and any supporting documents. Professional seals must have original t signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) A Print Name Brian McPeters, PE Address 1700 Willow Lawn Drive, Suite 200 City Richmond State VA Zip 23230 Daytime Phone(804) 672-4721 E-mail brian.mcpeters@kimley-horn.com `j *When applications and plans are reviewed,but not approved,and a response to comments isnot received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's Al signatures will not be considered valid. FOR OFFICE IISE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2 I Niiiii4 .1 a OE illy A VQ { Tw y ' 1 I COUNTY OF ALBEMARLE Office of Facilities Development 401 McIntire Road, Room 228 Charlottesville,Virginia 22902-4596 (434)872-4501 Fax(434)972-4091 TRANSMITTAL 1. TO: County of Albemarle Date: April 3, 2015 Community Development Department RE: Crozet North Sidewalk Project ,f a The following items are being sent ® Attached ❑ Via Fax ['Copy of Letter ❑ Specifications ❑ Shop Drawings Eg Plans ❑ Contract ® Other See below Plat ❑ Change Order COPIES DESCRIPTION } ° 1 VSMP Application ) 2 ESC Plans 1 2 SWPPP j ❑For Approval ❑Approved as Submitted ❑ Resubmit Original for Approval vI ❑For Your Use ❑Approved as Noted ; ❑ Submit Copies for Distribution 4 ❑As Requested 0 Returned for Corrections ❑ Return Corrected Prints } ® For Review and Comment ❑ For Bids Due 0 Prints Returned after Loan to Us CIFor Signatures g ,, Remarks: i Abc‘k,' 4 Signed: H Frank Po I (ext. 7914) i 3 If enclosures are not as noted,kindly notify us at once A