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Home My WebLink AboutWPO201500055 Application 2016-08-25 ` ' -Community Development Department ' ill !'-• Albemarle Coun b 401 totcirrtiLASoad Charlottesville,VA 229024595 #,.....,r1r Planning Application PARCEL / OWNER INFORMATION Application# WP0201500055 � ERTY c ~' ~~'~^'^`^` _=___ _1 ,-Description BRANCHLANDS PHASE 28 , Magisterial 0::;-: Rio �� Land Use Primer, Forest ! Current LT:: Not in A/F District • :urrent Zotung Pnmary Planned Unit Development '•i Entered Eiv Street Address 1 APPlication rtiVe. Water Protection Ordinances Received Date 08/24/15 i ge,:eived Date Finai IL, il- timitta Date Total Etts 1350 doting File Date 1 Subrmttal Date F,nal, Total Paid 1350' Revision Number comments ----��--------� ~ --~~~ --~� `~�^------�-�---^~ - -~^~ ---~ ^ - Leow *� ` � ' ' � --------' - ~ | - !SUB APPLICATION(s) . E rosion and Sediment Control Plan Stream Buffer Development Request APPLICANT /CONTACT INFORMATION 1209S GAVTON RD l PICHAMOND VA 2:.=;239 .919 2';•2 ET SE :CHARLOTTESALL •22902 4342271699 i Signature of Contractor or Authorized Agent Date - Virginia Stormwater Management Program (VSMP) Application for Albemarle County OF Project Name: SQ ANC-14LA JOS ( Moat(O4 & Ass IS-rel !^JViN( (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No QQ Is this a revision or resubmission for review? Yes 0 No X County File Number: (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. (0I —3-SA VAAL. L�G .. Shills Tax Map&Parcel Print Name of Property Owner Signa e wn Date 4,1 -3 -SD wl+s8 Le. t'Vlta ��l9lis Tax Map&Parcel Print Name of Property Owner Signature of 0 er 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 61tAt1AM ADELMAN 6.41/1i L. L.t.0 Address i 2O95' (1p{./-rp/J City12tcPNtoNA State VA Zip 2323$ Daytime Phone(q34) 413 134o0 E-mail a/c(N&-re_exE MSN,Com 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of 2 1 Li B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1 Acres to be Total Fee Fee Due with this Fee with Transfer or '; disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,7001,35 $200 5 and less than 10 $3,400 $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;$150 eC. Registration Statement on the official DEQ form. 243. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. BE. Stormwater Management Plan satisfying the requirements of code section 17-403. 2"F.E. Pollution Prevention Plan satisfying the requirements of code section 17-404. 3/G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. A)6/444, H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of s am buffers. /1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. '_/J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name SRA s(, KerARSe1 /-rim.s4thoS Gt?Olf Address i i q ZIV D ST. SE City, C tiAK i.orr C vi 1..i..C State VA Zip 22'90 Z Daytime Phone(d ' ) 72 7 iD GS E-mail CRA/(- ro7-,RTK/ ., ?+M MONf.Cour *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# n Fee Amount$ ()SO Date Paid$ � Cn.� -IPHSBy who? I , 1-1-C— Receipt# 1 b 1 1 OS noS l)3 6 By: i-S(z 7/1/14,Revised:7/10/14,1/7/14 Page 2 oft Pedro At c, �rk`'ke. COUNTY OF ALBEMARLE Department of Community Development 401 McIntire Road u�rnN+" Charlottesville,Virginia 22902 VSMP Application Completeness Check Project Title: l3ranc.k\aAS5 File Number: w k5 o 00 65 Date: _, �l] Reviewer: Your application has been checked for completeness per section 17-409 of the County Code. All items must be received and correct for the application to be deemed complete. ❑ This application is complete and plan review has begun ❑ This application is not complete. Please provide the missing items checked below. Received Correct Y ; N Y N N/A 0 Completed application ❑ El ❑ 1!/.7 0 Signatures of the Property Owners for each parcel affected ❑ ❑ ❑ EV-0 Correct Fees Paid ❑ 0 ❑ q,'❑ Registration Statement on the official DEQ form, with correct LDA 0 0 ❑ ❑ 0 Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ ❑ ❑ ❑ 0 Stormwater Management Plan satisfying the requirements of code section 17-403. 0 0 ❑ ❑ ❑ Pollution Prevention Plan satisfying the requirements of code section 17-404. The EPA template should be used. ❑ ❑ ❑ ❑ 0 Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. The EPA template should be used. ❑ ❑ ❑ ❑ ❑ Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. 0 0 0 ❑ 0 Requested Variations or Exceptions as provided in code sections 17-407 and 408, if applicable. (SSF, MMT,etc) ❑ ❑ ❑ ❑ ❑ Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. ❑ 0 0 Comments: ■