HomeMy WebLinkAboutWPO201600056 Bond WPO VSMP 2017-08-03 laernm t '•,,Drain '1,ij.-- 4411101q 59 SAr art44-C--
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Date Reverved: 7 I.:, Wu Fee Paid:
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Reeeived by: Al AIL,
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Intake: Foroa to Nianagement Anidyst
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REQUEST TO ESTABLISH A BOND
APPROVED PLAN # q4c).: - a016. - s6 c4,------
PROJECT NAME: MONS Ccoa. C-evi-Ter
(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 information must be correct,and plans must be
approved prior to bond estimates being prepared.
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TAX MAPs/PARCELs: 7g- Il OWNERN,IIMehgvA 'k CiVA, 1--1-/
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SIGNATURE: -.-i 'f ' date:-7—
TAX MAPs 1 PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAN/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;
XVESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; SO fee
XVSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208; $250 fie required
0 Subdivision (roads,drainage,etc.)per Subdivision Ordinance section 14-435:
& Water& Sewer per Subdivision Ordinance section 14-435; S269 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: CAI-LE UTIAO 0 41-:el ‘.0 o 1('TeT
OR REGULAR MAIL ADDRESS:
Revised 6/20/2014, 11/3,2015 lYt.,,N 1/6 i Y4A117
"` County of Albemarle 110190
Department of Community Development
PH: (434)296-5832 Date 60-
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RECEIVED_LROM: At j_ •. 11 .1
AMOUNT:
(A6 nc 'Tx' • t 1 0Ias ` �� $6,-.T:6,ae
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0 , a�324 510 - • r iy`
3
307 l
For:
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By ALAI Min
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12697
CHARLES W HURT, LLC UNION Union Bank&Trust tx
f / PO BOX 8147
imiiP.Prt�ae CHARLOTTESVILLE,VA 22906 68-316/514
6/30/2017
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PAY TO THE County of Albemarle
ORDER OF *250.00
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Two Hundred Fifty and 00/100,,.*********,,******************************.****************,****,,**************************.**
DOLLARS
iii, .,\,. County of Albemarle
401 McIntire Road
Charlottesville, VA 22903 a�,r., €xt/r4. Nrk.**0.4.,f [
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