HomeMy WebLinkAboutWPO201500040 Application WPO VSMP 2015-06-30 , libE'171a1''lE.i County _ Community Development Department
401 McIntire Road Charlottesville,VA 22902-45,96
4 ' Planning Application `.41001Voice 1)296-5832 Fax:(434)972-4126
PARCEL I OWNER INFORMATION
TMPI 076M1-00-0O-002g0 Owner(s): 5TH STREET STATION VENTURES LLC
Application# WPO2OI500040
PROPERTY INFORMATION
Legal Description I APACE PARCEL 2B ,,,
Magisterial Dist. Scottsville L; Land Use Primary Open
Current AFD Not in A/F District 2r.il Current Zoning Primary Planned Development Shopping Center
APPLICATION INFORMATION
Street Address Entered By
Application Type — i Emt_antz
Water Protection Ordinances . 34ily 2815
Project Moores Creek Bank Stabilization VSMP
Received Date 06/23/15 Received Date Final Submittal Date Total Fees 150
Closing File Date Submittal Date Final ; Total Paid 150
Revision Number
Comments
Legal Ad
SUB APPLICATION(s)
Type Sub Applicatio Ccfrenent
Stormwater Management/BMP Plan
Erosion and Sediment Control Plan
Stream]Blies? t1 .1,4* f' 3
APPLICANT I CONTACT INFORMATION
ContactType Name Address CityState Zip Phone PhoneCelJ
ne 51$STREETS-MON VENTURES t,t 5 WEST BROAD BTAte'STE€p IFAIRBURN ► l 3#1213
Preiaay Cortsct LANCE).KOTH 3159 HUGUENOT POINTE DR POWHATAN VA 23139 8442390814
Signature of Contractor or Authorized Agent Date
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See
of,tae
Virginia Stormwater Management Program (VSMP)
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Application for Albemarle County : ,,t�
Project Name: Moore's Creek Bank Stabilization and Buffer Area Work
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ® No ❑
Is this a revision or resubmission for review? Yes 0 No 0
County File Number: (to be provided by the County for new applications)
The following are required elements of new .pplica '.ns[from code section 17-401.1 For revisions or
amendments,please indicate which items ended. 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.
111
76M1-00-00-002B0 5th Street Station Ventures, LLC 4ilty 120 Vvi W-- ( X '2-0 I
Tax Map&Parcel Print Name of Property Owner Signature of 0 r 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
Tax Map&Parcel Print Name of Property Owner Signature of Owner Date
Contact Information for the Owner(s)to receive correspondence:
Print Name Bruce Lucas
Address 5 West Broad Street Suite B
City Fairburn State GA Zip 30213
DaytimePhone(617) 671-9735 E-mail Bruce@SJCollinsent.com
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0 B. All Fees [Code section 17-208]
For new or modified plans;Total acres proposed to be disturbed
Acres to be Total Fee Fee Due with this Fee with Transfer or
disturbed Application modification of permit
Less than 1 $290 $145 • $20
1 and less than 5 $2,700 $1,350 $200
5 and less than 10 $3,400 $1,700 $250
10 and less than 50 $4,500 $2,250 $300
50 and less than 100 $6,100 $3,050 $450
100 and more $9,600 $4,800 $700
For(minor)amendments to an approved plan;$200 per review
Varia - 1 .errequest)
itigationPlan;$150
❑ C. Registration Statement on the official DEQ form.
❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
▪ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents;
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Lance J. Koth
Address 3159 Huguenot Pointe Drive
City PowhatanState VA Zip 23139
Daytime Phone(804) 239-0814 E-mail Lance@ Koth.cc
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Pee Amount$ `3" Date Paid 6-93-15 By who? S.+h 5f U e ,J vv c Receipt# iO t7 3?76,Ck# tat By: /5
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