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Inttsket Vomited to Management Analyst •
REQUEST TO ESTABLISH A BOND
APPROVED PLAN # JP° 1014- —0003g
7,
PROJECT NAME: tAliA roV4l..1 r ,‘00123 2-0.44thr'
(As listed on the approved pl. )
All parcels in the project, including any off-site work if easements are not provided, and current owners. Use
separate sheet if more owners are required. Owner and tax map information must be correct,and plans must b
approved prior to bond estimates being prepared.
•
TAX MAPs/PARCELs:5qP2-1—i 5 OWNER'S NAM 141/4 hAST Petok-.07 ,
SIGNATURE:
date:
TAX MAPs/PARCELs: 143 OWNER'S NAME: U.V_A 4110%)00177zn...)
SIGNATURE: date:ct \1
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; SO fee
VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208; 5250 fee required
0 Subdivision (roads, drainage, etc.)per Subdivision Ordinance section 14-435;
& Water& Sewer per Subdivision Ordinance section 14-435; 5269 fee required
A bond estimate will he prepared by the plan reviewer. The estimate must he sent to the owner. Please provide
contact information.
EMAIL: Ai PCIL1Z)v5IA fi 0D, -T1COrr.
OR REGULAR MAIL ADDRESS:
Rev is4d 6/20/2014, 11/3/2015
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