HomeMy WebLinkAboutWPO201600051 Bond WPO VSMP 2017-04-04Jateraal Liss 4
t0
Date Received: FeetI 40V .
Received by: f 1
Ce/?'
Intake: Forward to Man dement Analyst
e )/ - fps
REQUEST TO ESTABLIS 'A BOND f i 4/004t,4 l
APPROVED PLAN#WP0201600051 jabi1-?
PROJECT NAME: Crozet Phase 3 Water Main Replacement Project 1:
As listed on the approved plan)
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 information must be correct, an• plans must be
approved prior to bond estimates being prepared.
sTAXMAPs/PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAPs/PARCELs: OWNER'S NAME:
SIGNATURE: date:
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 thatthepersonsigningabovehastheauthoritytodoso.
The requested estimates are;
Ga VESCP Erosion & Sediment Control per Water Protection Ordinance section 17-207; 50 fee
VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per WaterProtectionOrdinancesection17-208; $250 fee required
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 be prepared by the plan reviewer. The estimate must be sent to the owner. Please providecontactinformation.
EMAIL: JLYNN@serviceauthority.org
OR REGULAR MAIL ADDRESS:
Revised 6/2012014,11/3/2015