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HomeMy WebLinkAboutWPO201500083 Bond Request 2016-03-01 Internal Use Onl C�, pF /J�7L/2rJ e, Fate Received: / Fee Paid: r� ALB ; Received by: AL I7 ® Intake: Forward to Management Analyst U ©�» tkikrifr t/112/€14/4 414/247 e I'IRGINIP fri i daye-i h"3 J ' /I' / /� a/ REQUEST TO ESTABLISH A BOND / '�-� APPROVED PLAN # of d CSD/ - 6)616G16 S�P�- .� t�Pva�5 PROJECT NAME: � i//`�SJR/Jr Zys,'fs.c M' (his listed on the approved plan) All parcels in the project, including any off-site work if easements are not provided, and current owners. Use a separate sheet if more owners are required. Owner and tax map information must be correct, and plans must be approved prior to bond estimates being prepared. /44r AX MAPs/PARCELs: 3l" 21 OWNER'S NA A: giLL�- SIGNATURE: date: � , 3/ TAX MAPs/PARCELs: OWNER'S NAME: SIGNATURE: date: TAX MAPs/PARCELs: OWNER'S NAME: SIGNATURE: date: TAX MAPs/PARCELs: OWNER'S NAME: SIGNATURE: date: TAX MAPs/PARCELs: OWNER'S NAME: SIGNATURE: date: NOTE: If ownership of the property is in the name of any type of legal entity or organization including, but not limited to the name of corporation, partnership, limited liability company, trust, association, etc., documents acceptable to the County must be submitted certifying that the person signing above has the authority to do so. The requested estimates are; ❑UVESCP Erosion& Sediment Control per Water Protection Ordinance section 17-207; $0 fee lY1 VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water Protection Ordinance section 17-208; $250 fee required ❑ Subdivision(roads, drainage, etc.)per Subdivision Ordinance section 14-435; &Water& Sewer per Subdivision Ordinance section 14-435; $269 fee required A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide contact information. f J EMAIL: Q` o 7 C� (n) L69 X41 t.,,CO3 'I OR REGULAR MAIL AD] KESS: f ..r-J SUtLi2 tt g fySte- Z2 536 Revised 6/20/2014, 11/3/2015 O t r n Nr . * II , y.` "s O .4, }g� ;' b N. p.��. Y * SQi 0IPE I I o f1..1 I E (Ni,....., M - :r O * * .a I U °' '° N * m is 0 � 4, ; * 1 1* •-• Q * le lo * r` 0. * ? Q I 41 m C ---._ Q(NI 0. 00 Z. Q �'°< .. r. I u- o �, � ., USN EQ ` ; M wc , � Li.< p¢ _ et RI'W tl1 3 Q 3 L Q.0