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HomeMy WebLinkAboutWPO201700047 Application 2017-07-17 l� a -�e ,r Community Development Department t" 441 McIntire Road Charlottesville.VA 22902-4596 14 Planning Application :1434 296-5832 Fax:(431)972-4126 PARCEL/ OWNER INFORMATION TMP 061K0-06-OC-00100 Owner(s): FORLOINES INVESTMENTS LLC Application# WPO2OI700047 PROPERTY INFORMATION Legal Description I BARTERBROOK 1 C 1 Magisterial Dist.!Jack Arnett Land Use Primary Residential--Two family (e.g.duplex) Current AFD Not in A/F District Current Zoning Primary R4 Residential APPLICATION INFORMATION Street Address B 1725 SOLOMON RD CHARLOTTESVILLE,22901 Entered By Jennifer Rntcl Application Type Water Protection Ordinances 6,x20-U17 Project Barterbrook Phase 2 Water Main Replacement Project Received Date 06/16/17 Received Date Final Submittal Date 06/19/17 Total Fees 150 Closing File Date Submittal Date Final Total Paid 150 Revision Number Comments • Legal Ad SUB APPLICATION(s) Type Sub Applicatio Comment Stormwater Management/BMP Plan 06/19/17 • Erosion and Sediment Control Plhn 06/19/17 APPLICANT /CONTACT INFORMATION ContaactType Name Address CityState Zip Phone PhoneCeli O,,, 4i FORLOINES INVESTMENTS LLC P 0 BOX 7018 CHARLOTTESVILL 22406, Primary Contact JEREMY M LYNN,PE-ACSA 166 SPOTN.AP RD CHARLOTTESVILL 22911 4349774511 Signature of Contractor or Authorized Agent Date *40101 ‘.111111, 4443V Virginia Erosion and Sediment Control Program (VESCP) . Application for Albemarle County i : ��RCINIr (This application is only to be used for projects exempt from the Virginia Stormwater Management Program,VSMP,and the DEQ General Permit) Project Name: Barterbrook Phase 2 Water Main Replacement Project(Project No. 2017-02) (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 County File Number: (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. 0 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. 0610-06-0C-00100 Forloines Investments, LLC (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 061K0-06-0B-00400 Berkshire Associates LC (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 061 K0-09-00-00200 Berkshire Associates LC (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 0610-05-0C-00300 Joseph M Lawson (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date ***See next page for continuation *** Contact Information for the Owner(s)to receive correspondence: Print Name Albemarle County Service Authority (Attn: Jeremy M. Lynn, PE ) Address 168 Spotnap Road City Charlottesville State VA Zip 22911 Daytime Phone(434) 977-4511, Ext. 114 E-mail jlynn@serviceauthority.org 7/1/14,Revised: 7/10/14, 1/7/15 Page 1 oft Virginia Erosion and Sediment Control Program Application for Albemarle County Section A(continued): 061 K0-10-00-000A1 Leimon Thomas or Virginia L Miller (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 061 K0-10-00-000A2 Brian B or Jennifer M Gillispie (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 061K0-10-00-000A0 Brian B or Jennifer M Gillispie (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 061 K0-05-00-00100 AM Holdings LLC (easement to be acquired) TBD Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Pi B. All Fees [Code section . 0207] Total acres proposed to be disturbed 0.2451 Acres to be disturbed Total Fee Less than 1 $150 per review More than 1 $300 per review For amendments to an approved plan;$200 per review Variances;$150(per request) Exceptions;$240 Mitigation Plan;$150 Construction Record Drawing;$300 • C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ E. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O F. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Michael Baker International, Inc. (Attn: Warren Wilczynski ) Address 272 Bendix Road, Suite 400 City Virginia Beach State VA Zip 23452 Daytime Phone(757) 631-5451 E-mail warren.wilczynski@mbakerintl.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY -h WPO# ck17-' J Fee Amount$ ,0vDate Paid 62,/64713y who? pe,s/4 )Receipt# l /cog g Ck#5 3,5j By: 7/1/14,Revised: 7/10/14, 1/7/15 Page 2 of 2 I .'- , . . ,7,11 .4„. ..„. , , ,.2) i . a 40.. s fi-,-7-,„-,.r.• '7 ',„. ...-„. 0 0 .:*•• - Y .., ,,, . 4 . 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