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Home My WebLink AboutWPO201600056 Application WPO VSMP 2016-09-26 Albemarle Cot., .r.'y 4 :intqeRC,,,,id - Planning Application IPARCEL / OWNER INFORMATION 07800-00-00-01100 ALBEMARLE LAND LLC Application g 1/1/P0201600056 PROPERTY INFORMATION LE;E Descript,:- ACREAGE 1 Magjster!al 2 Rivanna Land Use Primary Residential — Smgle-family (incl. modular home' •I - Not in A/F District •! Current Zoning Primer), Highway Commercial APPLICATION INFORMATION .;.1dress Entered By TyPe Water Protection Ordinances 7.1 nrilfer Smith te, 9/26/2016 Project Monscane Center eceived Date 09/23/1 6 Pe: ad Date nal 5,Jbmttal Date, I Total Fees 1350 Closing File Date Sobmittal Date Final TOtal Paid 1350 Reion Numb Comments Leg& SUB APPLICATION(s) Sub.4pplicato Iotorniv/Ater Management/6MP Plan 09/26/16 Erosion and Sediment Control Plan 09/26/16 . . APPLICANT CONTACT INFORMATION Phone PhoneCelt 4349798121 Date • ✓ cfat gk, Virginia Stormwater Management Program (VSMP) * % Application for Albemarle County 4.159K- Project ��Rci'.sr Project Name: MonSC.t^.n c (The name should be the same as it appears on plans) / Is this an amendment to an approved plan? Yes ❑ No C�' / Is this a revision or resubmission for review? Yes 0 No L7 County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. 13'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. 7 - 11 Cierarlts W . H r4- 7. 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Address City State Zip Daytime Phone( ) E-mail 7/1/14. Revised: 7/10/14. 1/7/14 Page 1 of 2 C7 B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $20 1 and less than 5 $200 5 and less than l0 $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;$150 GC. Registration Statement on the official DEQ form. CID. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 1E. Stormwater Management Plan satisfying the requirements of code section 17-403. C/F Pollution Prevention Plan satisfying the requirements of code section 17-404. 0'G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. tP 0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. NU+ 0 I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. N ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name IJ vk s '9‘ Ge-t <'�e Address 1 Z Sr [�� o P� ®r. City C k"r ( C r/11 C State V Zip 2 Zi I t Daytime Phone(334) 11 D ' '( Z I E-mail ot)r ( LI t d aI'%k:co^ city C 2+%.. *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO#011W-5 1 �11 (y� Fee Amount$')) t atePaid Cl( 1ywho?Oh s ,qUitReceipt# 1"W3ACk# I(6}33 By:JS• 7/1/14.Revised: 7/10/14. 1/7/14 Page 2 of 2 Virginia Stormwater Management Program (VSMP) AApplication for Albemarle County ® i� PP � '" tom~ Project Name: M O n S co v1 e C ¢,n +e (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No Q' Is this a revision or resubmission for review? Yes r No D County File Number: W P 0 2.0 I(.000gg(e (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. 75- 11 GtarIts ). Nmr* &L49/ LJ 9/7 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Address City State Zip Daytime Phone( ) E-mail 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of2 N B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 11,q 0 F¢e al r tg a , r ft.'+d 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 $2,700 $1,350 $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;$150 M s/ . Registration Statement on the official DEQ form. CID. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. C"E. Stormwater Management Plan satisfying the requirements of code section 17-403. 131. Pollution Prevention Plan satisfying the requirements of code section 17-404. [VG. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N(fA►H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. tit4 I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. Mii0.1. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name p N G r t t ^ n Q Address , 1 Z SD... (7.,,. haf S P r. City A l t State VA' Zip 1,7A.D L Daytime Phone(43q) a - a1ii �2 I E-mail n�/' t,t /+ t e pR o i►�1 i n,•✓� C"5. M *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of2