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
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