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Home My WebLink AboutWPO201500038 Application WPO VSMP 2015-06-22 Community Development Deo a rtmelt ,1:4k,l1V. Albemarle Cou—Ly ntireRoad Charictiesviiie,VA 22902-4596 :.•:'., °4—q ice;(434)29E-5332 Fax i4341 972-4126 'Nor Planning Application IPARCp.—ir OWNER INFORMATION_ — 06100-00-00-16400 :INner(s': SHEPHERD, VALERIE M „ Application# WP0201500038 PROPERTY INFORMATION ,..E...-.;a ::Es:,:• :,- ACREAGE , 1 Rio -ii.- i Land Use Pnmar. Residential -- Single-family (incl. modular home Not in A/F District :01 Current Zoning Prirriary R4 Residential Llii APPLICA T ION INFORMAT ION — street Address 965 RIO RD E CHARLOTTESVILLE, 22901 Entered By anisette Roth v Application Type Water Protection Ordinances :1 .„,., 16122/2015 Project Dunlora V - VSMP Received Date 06/22/15 a e ce ,ed Date E--,a ' 5,,t.rn,tta€ Date Total Fees 1350 Closing File Date Submittal Date Final ----1 Total Paid 1350 Revision Number L :omments 1- ,.. .,... Legal Ad . iSUB APPLICATION(s) Sub '',,vi,Icatio' C.:7,-irert ., Erosion and Sediment Control Plan Stormwater Management/BMP Plan Stream Buffer Development Request APPLICANT ! CONTACT INFORMATION , - '--; . ----t3OTIPel -,,..iesS - CityState 1-27-11, 1 Pilaw - PhoneCeil -, .. .- - -- -....--.= :- -_:,-- EEFIEri NT '07086 . .. .. .„......., ..., i.„...„.„.„. , . _ , „ _ :-,ARL -El.:__ 22902 4343271689 •=-.*.--orized Agent tr Virginia Stormwater Management Program (VSMP) 47. Application for Albemarle Count -1,4011;" Project Name: 'DON L )RA (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No Is this a revision or resubmission for review? Yes 0 No r County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401J. 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,1 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. Gl-ley V fczr�c V_ spp , �/ tt-A /I '/, - Tax Map&Parcel Print Name of Property(iwner Signature of Owner1//4/66--- to 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 Li B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed Acres to he 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 $2,700 350 $200 L5,and less than 10 $3,400 ' $1,700 $250 0 and less than 50 $4,500 $2,250 $300 50 and less than 100 $6,100 ; $3,050 $450 100 and more $9,600 1 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150(per request) Mitigation Plan;$150 -F'C. Registration Statement on the official DEQ form. [YD. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. Stormwater Management Plan satisfying the requirements of code section 17-403. 'F. Pollution Prevention Plan satisfying the requirements of code section 17-404. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. .Y1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name _cm I(;y . ,Ko7AK'Se1 Artmmews_C7_ Address t q &id c-r -S " City C� State 1A Daytime Phone(4,14 2-7 tQi E-mail , i , h ": _ t!''!yyc7rjS *when applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# 3c0 Fee Amount$ "60` Date Paid L ), \ By who? t`Gyp t Cr-Ire()Receipt# 100 344 Ck# S L i`, 7/1/14, Revised:7/10/14, 1/7/14 Page 2 of 2