HomeMy WebLinkAboutWPO201500040 Preconstruction Form WPO VSMP 2014-08-29 Request for Pre-construction Meeting and Grading Permit ' '',
from Albemarle County
Approved Plan Number WPO- Q C'cD 4 a
Approved Plan Name: W1 P ti
Moo 1f�nr�F�S �J2Pe1t�. iglL�TtovN, Bu:cest2AVIA
(Plans must be approvedCt58
prior to a pre-construction meeting.) '
Bond approved date: to '\1 L i.o 1 S'
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber. y�
Print Name: E i (1,5 t4 ) F
State Certification Number: 404 t/f
Address I � RAN la T2)VZtt9 e—+6,0 1 L I A
City �„� r� 2 State Zip 30 Z ; 4
Daytime Phone(04) T J4 �q 2 — E-mail bet/4.7.4e h t . ; Lt.
Primary Contractori� c
Print Name �/�„` an...A.pl.A.,1
AddressJt-—� p� �_
City .' i t • State q44 Zip 30 2--
Daytime
Daytime Phone .(TAD Lk,/ 154.05 5 E-mail ..�J4,-‘117-1.r.( 619 . Let,
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
1 and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
• 100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised:8/29/14 Page 1 of 3
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Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
*get 6414 IZI.5K-op "ESSC _ 440`k (4-3+
tA) tiewt'S eSe- 60143 0(11' 2—ot,..e=.
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Pernik Issued Date
By who?