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REQUEST TO ESTABLISH AB ND (,c9'
APPROVED PLAN# SUB201400067&WP0201400031 //t&IA6G-11 1
PROJECT NAME: WESTLAKE HILLS _ SQL 1)II'. /
(As listed on the approved plan) i� , / gait)
All parcels in the project, including any off-site work if easements are not provided,and current owners. Use a
separate sheet if more owners are required.Owner and tax map informati mu be correct,and plans ust be •
approved prior to bond estimates being prepared. /I
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TAX MAPs/PARCELs: 56-95A OWNER'S NAME. LICKING OLE CREEK, LLC
SIGNATURE: date: 3/30/2016
TAX MAPs/PARCELs: 56-95B OWNER'S NA LI KIN OLE CREEK, LLC
SIGNATURE: .— date: 3/30/2016
TAX MAPs/PARCELs: 56-53 OWNER'S NA LI I GHOLE CREEK, LLC
SIGNATURE: ,ate date: 3/30/2016
TAX MAPs/PARCELs: OWNER'S NAME:
SIGNATURE:
TAX MAPs/PARCELs: OWNER'S NAME:
SIGNATURE:
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;
0 VESCP Erosion& Sediment Control per Water Protection Ordinance section 17-207;$0 fee
® VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208;$250 fee required
el Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435;
& Water& Sewer per Subdivision Ordinance section 14-435;$269 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
EMAIL: alan@riverbenddev.com
OR REGULAR MAIL ADDRESS: 455 SECOND ST SE,SUITE 400
CHARLOTTESVILLE, VA 22902
Revised 6/20/2014. 11/3/2015
V ®2014 INTUIT INC p 157 '�
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