HomeMy WebLinkAboutWPO201500035 Bond 2015-09-10 -pp -reDd4
Internal Use Only '+1mioe
Date Received: q IO Fee Paid: OS— , 4115WS
LRnReceived by: j'C`V�.--
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Intake: Forward to Management Analyst � ��I
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REQUEST TO ESTABLISH A BOND
APPROVED PLAN # WHO ' i015 0003S
PROJECT NAME: /;v4kHcy 4,vai tAA,- f'e 110.;.,
(As 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 inf mation must be correct, and plans must be
approved prior to bond estimates being prepared. Iv1(� CL h m Ay
TAX MAPs/PARCELs: 326, 'C OWNER'S NAME: tAhOa d rihv 40C/‘; 71--
SIGNATURE:
SIGNATURE: �� j�� ' date: oJ•- i.f
TAX MAPs/PARCELs: 3 2 64 OWNER'S NAME: Vti;v'evdi o4 U4 Fw,421i•0h
SIGNATURE: t✓Vt K=im� &iron date:?//s--
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;
❑ VESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; $0 fee
VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208; $250 fee required
El Subdivision(roads, drainage, etc.)per Subdivision Ordinance section 14-435;
& Water& Sewer per Subdivision Ordinance section 14-435; $250 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
EMAIL: (,LGY64 g 1/44,ho(• ot-q
OR REGULAR MAIL ADDRESS: �J
Revised 6/20/2014
9 5 5 2 4
BANK AMERICA
RIVANNA WATER & SEWER AUTHORITY 68-1-510
OPERATIONS ACCOUNT
695 MOORES CREEK LANE
CHARLOTTESVILLE,VA 22902-9016 DATE AMOUNT i
9/10/2015 $250.00
PAY
Two Hundred Fifty Dollars and 00 Cents
> .
a,-
VOID AFTER 90 DAYS
TO THE
COUNTY OF ALBEMARLE
6
DEPT. OF COMMUNITY DEVELOPMENT
ORDER
401 MCINTIRE ROAD
OF
CHARLOTTESVILLE VA 22902 . 0,10147(//C.-- 4/...: /
UTHORIZED SIGNATUR
III 09 55 240 1:0 S L0000 L71: 0000 L L a 3 2 3 9 Bo
County of Albemarle 1 0132 3
Department of Community Development
PH: (434)296-58329 - / 0 - I
Date RECEIVED FROM: 12 V 0,:lt ICA GU i '4' e' `," ..)e i....-0.., .,
AMOUNT: 17-,..* k vv,dr 4,) f ,c. 4--. c-',:j :,-, ----- - — -- ---- $
307 308 IN as-Vc 510 (cheCk'
%.,
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For: t'''''.•Pti‘4,,,t c't -TC> l'''''',,-4,;-1C.,>t c 1:--) ':"- b0,I1, .,C). cash
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I... ? :::'t::} -.,()1 C:7 credit card i ,,c•-::t-
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