HomeMy WebLinkAboutWPO201500021 Preconstruction Form 2016-03-28 pF-1Lp�
Request for Pre-construction Meeting and Grading Permit
from Albemarle County
'a cr�`1r
Approved Plan Number:WPO- -00021
Approved Plan Name: Crozet Avenue North Sidewalk Project
(Plans must be approved prior to a pre-construction meeting.)
,t
Bond issued date: N/A Bond Number: N/A
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print• Name: C"
r . ti
State Certification Number: L. (67
{?r
' 3 Daytime Phone , Q 0.0 W't'"1
4 Primary Contractor:
Print Name 1 n C o yct C
Address 7 El 1 t S La 11-
'l �_�� �j
City I'1 ' 1�%}, "C.> State �' Zip )- "'T gO
Daytime Phone 'O) 9�t 0_ 1 ) E-mail t a rl c®,,) c- 4�` ,f)A rl eJ-
=wI
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
3 Total acres proposed to be disturbed is contained on the approved plan and application:
4 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.
I
7/1/I4,Revised:7/10/14 Page 1 of 3