HomeMy WebLinkAboutWPO201700005 Application 2017-03-20Virginia Stormwater Management Program (VSMP) 1
Application for Albemarle County All
Project Name: Timberland Park Apmnts
(7he name should be the same: as it appears on plans)
Is this an amendment to an approved plan? Yes 0 No 64
Is this a revision or resubmission for review? Yes No 11
County File Number:. WPO201700005 (to be provided by the County for new applications)
The following are required elements of new applications ffrom code section I7 401]. For revisions or
amendments, please indicate which items are being amended, Signatures must be provided for any
submission.
91 A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT
TO RE SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I hereby certify that sill 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. 1 hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits. If
07600-00-00-046B0 Timberland Park VA, LLC
Tax Map & Parcel Print Name of Property Own•
of Owner
FA
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
Contact Information for the Owner(s) to receive correspondence:
PrintNamoden Surber
Address 2021 Cross Beam Drive
City Charlotte state NC Zip 28217
Daytime.Phone (704) 357-6000 E-mail jensur4or@sotberdev.com
7/1/14, Revised: 7/10/14, 1/7/14 Page I oft
m B. All )lees [Code section 17-208]
For new or modified plans Total acres proposed to be disturbed 5.5 acres
Acres to be
disturbed
Total, Fee
Fee Due with this
Application
Fee with Transfdr or
modification of permit
Less than 1
$290
$145
$20
I and less than 5
$2,700
$1,350
$200
5 and less than 10
$3,400
$1,700
$250
10 and less than 50
$4,500
$2,250
$3.00
50 and less than 100
$6,.100
$3,050
$450
100 and more
$0,600
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances $150 (per request)
Mitigation Plan; $150
0 C. Registration Statement on the official DEQ form.
D. Erosion and Sediment -Control Plan satisfying the requirements of code section 17-402.
0 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
0 G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405..
1 V H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
001, Requested Variations' or, Exceptions as provided in code sections 17-407 and 408.
OJ. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies ofall plans and any supporting documents. Professional seals must have original
signatures.
Additional information f not provided on plans and documents:
Name of a Contact Person. for correspondence (usually the plan preparer, consultant or agent)
Print Name Kent O'Donohue (13alzer 4 Associates)
Address 1561 Cortlmetce Road, Suite 401
City Verona
State VA Zip 24482
Daytime Phone (540) .248-3220 E-mail dodonohue@bal2er.cc
*When applications and plans are.reviewed, but not approved, and a response to comments is not received within 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 WPt) #
Fee Amount $ Date Paid By whol Receipt # Ck#By:
7/1114, Revised: 7/10/14, 1/7/14 Page 2 of 2