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Home My WebLink AboutWPO201600055 Application 2016-09-12 Albemarle / Community Development Department st' � Einar,e O 401 Mrintire Road Charlottesville,VA 22902-4596 :(434)296-5832 Fax:i434)972-4126 Planning Application PARCEL/ OWNER INFORMATION TMP 08600-00-00-11500 Owner(s): KLEIN,ROBERT&MARY BELEFSKI,TRS OF THE KLEIN LIVING Application# WP0201600055 PROPERTY INFORMATION Legal Description a FA1tlt H17 Magisterial Dist.1 Samuel Miller Land Use Primary Open Current AFD LNot in A/F District 10 Current Zoning Primary i Rural Areas El APPLICATION INFORMATION Street Address Entered By �.._ ifer Pritchett Application Type Water Protection Ordinances T, Project Klein Residence Received Date 09/09/16 Received Date Final Submittal Date 09/12/16 Total Fees 150 Closing File Date Submittal Date Final Total Paid 150 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Appiicatio:, Erosion and SedirnmetContiNo. $ i..._ �� .... w..... _...... . APPLICANT /CONTACT INFORMATION CentactType INave Address I CityState Zip Phone PhcneCell owneroicouint . MISERY&MAR*B'ELEFSKI,TRS s 342,DfEHL cr i FALLS CHURCH' I 22041 Primary Contact JUSTIN WALTON,PM ELEMENT 101 E HIGH ST CHARLOTTESVILL 22902 4348065410 Signature of Contractor or Authorized Agent Date Virginia Erosion and Sediment Control Program (VESCP) .11P = Application for Albemarle County (This application is only to be used for projects exempt from the Virginia Stormwater Management Program,VSMP,and the DEQ General Permit) Project Name: :11 ke S 1CL w`) (The name should he the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No 14 is this a revision or resubmission for review? Yes 0 No)4 County File Number: (to he provided hr the County far new applications) The follott'ing are required elements of new applications [from code section l 7-4011. 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. 08600-00-00-11500 No,r .4 E. xi /,„ /7 Tax Map&Parcel Print Name-df Property Owner Sigtriature wn Date 08600-00-00-11500. ,C.t 1k le ,J `r�e/�.. Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map& Parcel Print Name of Property Owner Signature of Owner Date Tax Map& Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Mary& Robery Klein Address 3425 Diehl Ct City Falls Church State VA Zip 22041 Daytime Phone(703) 575-9047 F.-mail Robert- rbtkln05@cs.com, Mary- MaryL2002@earthlink.net r g B. All Fees [Code section 17 ] sow, Total acres proposed to be disturbed 0.95 #C, Acres to be disturbed Total Fee --b 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;$300 Ef C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. O E. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ F. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Justin Walton, PM Element Construction Address 101 East High Street City Charlottesville State VA Zip 22902 Daytime Phone(434) 806.5410 E-mail justin@elementbuild.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# £ DIU.—0 SS Fee Amount$ 1 5D.co Date Paid g h g i,By who?elta>et 4 CONAr. Receipt# 000741' Ck 4/8 By: .._.)p 7/1/14,Revised: 7/10/14, 1/7/15 Page 2 of 2 Virginia Erosion and Sediment Control Program (VESCP) Application for Albemarle County t (This application is only to be used for projects exempt from the Virginia Stormwater Management Program,VSMP,and the DEQ General Permit) Project Name: k k7 ir1 ke 5,d ti c_ e. (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 .•vision r resubmission for review? Yes X No 0 County File Number: iiiiPt,/i l u a00Cys (to be provided by the Counts for new applications) The following are required elements of new applications/front code section 17-4011. 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. 08600-00-00-11500 &. r"'q E kik tt) V' ?�? - LI/7k Tax Map&Parcel Print Name--cif Property Owner Si aturc wn Date 08600-00-00-11500 E040.i- k iv5;�« VF/4 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner [)ate Contact Information for the Owner(s)to receive correspondence: Print Name Mary& Robery Klein Address 3425 Diehl Ct City Falls Church State VA Zip 22041 Daytime Phone(703) 575-9047 r:-mail Robert- rbtkln05@cs.com, Mary- MaryL2002@earthlink.net `.r/ 0 B. All Fees [Code section 17-207] Total acres proposed to be disturbed 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; $300 ❑ C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. O E. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ F. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Justin Walton, PM Element Construction Address 101 East High Street City Charlottesville State VA Zip 22902 Daytime Phone(434) 806.5410 E-mail Justin@elementbuild.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14, 1/7/15 Page 2 of 2