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Home My WebLink AboutWPO201500089 Application WPO VSMP 2015-11-02 WI!' Albemarle ) ,,fntt,/ Community Development Departn ,r„'' I 401 McIntire Road Charlottesville,VA 22902-4E sr. u Voice:(434)296-5832 Fax:(434)972-4. Planning Application PARCEL J OWNER INFORMATION TMP 056A2-01-00-07200 Owner(s): CLAUDIUS CROZET PARK INC Application # 14,130201500089 PROPERTY INFORMATION Legal Description 1 ACREAGE PARCEL Al CLAUDIUS CROZET POOL Magisterial Dist. LWhite Hall . Land Use Primary Commercial Current AFD Not in A/F District fiCurrent Zoning Primary [Rural Areas [APPLICATION INFORMATION — — Street Address 1075 CLAUDIUS CROZET PARK CROZET, 22932 Entered Application Type Water Protection Ordinancesi JUdY Martin I Project Claudius Crozet Park Parking Lot Renovation Received Date 11/02/15 Received Date Final Submittal Date Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Application Comment Stormwater Management/BMP Plan �� ..'c �,` ,. .. �'` �t «P APPLICANT/ CONTACT INFORMATION CityState Zip Phone I PhoneCi OWnerfAPPllcant �CLAUDIUS CROZET INC I P 0 BOX 1718 CROZET VA 22932 Primary Contact CLAUDIUS CROZET PARK, INC. - KIM GUE P. O. BOX 171 CROZET, VA. 22932 4349965868 Signature of Contractor or Authorized Agent Date ,,\ \1/f1 Virginia Stormwater Management Program (VSMP) Jrr/L Application for Albemarle County Project Name: Claudius Crozet Park Parking Lot Renovation (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 ❑ No e County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]. For revisions or amendments, please indicate which items are being amended. Signatures must be provided for any submission. e A. Signature of the Property Owner for each parcel: (Required with every submission or revision, N 0 T 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. 56A2-01-72 Claudius Crozet Park, Inc. ✓ / — -?7 �l Tax Map&Parcel Print Name of Property Owner Si ture of Owner Date 56A2-01-72A Claudius Crozet Park, Inc. - 7e; -- L ? Tax Map& Parcel Print Name of Property Owner Sig ure of wner 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 NameClaudius Crozet Park, Inc; Kim Guenther Address P.O. Box 171 City Crozet State VA Zip 22932 Daytime Phone(434 ) 996-5868 E-mail guentherkim@gmail.com 7/1/14.Revised: 7/10/14. 1/7/14 Page 1 of 2 *owe '440.01 ® B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1.84 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 Variances;$150(per request) Mitigation Plan;$150 ® C. Registration Statement on the official DEQ form. D D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ▪ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Address City State Zip Daytime Phone( ) E-mail *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be':considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ _Date Paid By who? Receipt# Ck# By 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2