HomeMy WebLinkAboutWPO201600006 Bond WPO VSMP 2016-07-17 TO : Td d —'.2 I/311
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REQUEST TO ESTABLISH A BOND (c.'
APPROVED PLAN #WPO-2016-00006
PROJECT NAME: Sentara Martha Jefferson Hospital-Helipad
(As listed on the approved plan)
All parcels in the project, including any off-site work it easements are not provided. and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must he correct,and plans must be
approved prior to bond estimates being prepared.
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TAX MAPs!PARCE Ls:7*.91, 7,31/ OWNER'S : Jo ,-than : s. —
SIGNA'fURE: _ .!!)j _ _. ._ date:�j–i__
TAX MAPs/PARCELs: OWNER'"AME:
SIGNA PURE:_ date:
TAX MAPS!PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAPs/PARC'ELs: 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- na.r..o. 't u • • ny,
trust, association,etc., documents acceptable t hat
the person signing above has the authority to
The requested estimates are:
❑ VESCP Erosion & Sediment Control per
-70 - 04/1
QJ VSMP Erosion and Sediment Control, Sto
Protection Ordinance section 17-208: S25(
❑ Subdivision (roads,drainage,etc.)per Sub(
& Water& Sewer per Subdivision Ordinar.
A bond estimate will be prepared by the plan reviewer. wide
contact information.
EMAIL: JSDAVIS1@sentara.com
OR REGULAR MAIL ADDRESS: 500 Martha Je _-.-_, �......,ueavme, V
22911
RCN i,:d 0:241.2014. 11,3.2015