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Home My WebLink AboutWPO201700023 Application Minor Amendment 2018-03-20 64 )C1- ^, AL p1; Virginia Stormwater Management Program (VSMP) �� ' Application for Albemarle County ® Project Name: O4i(1eçk (The name should be tsame as it appears on plans) Is this an amendment to an approved plan? YesNo ❑/ Is this a revision or resubmission for review? Yes lzT No ❑ County File Number: Y►PP z 9/ )_at7 PZ .-5 (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. VA. 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. Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map& Parce Print Name of Property Owner / Signature of Owner I ate 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: k/ S 1� I4f .�r/c /Lc Print Name L it /Gi Address 692 Boitz * diutzt.e. City ZAfrip 7/l5 Vs//L State VA Zip 22901 Daytime Phone V// ) 020`3527 E-mail Qee#�4ecay f/t49,5,irlda•A CDOrn 7/1/14, Revised: 7/10/14, 1/7/14 Page 1 oft 7 . All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1, g 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 F mirror"amendments to an approved plan; $200 per revie iances; $150 (per request Mitigation Plan; $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 44' �/Q/)!? l:/1 Address d' Z 7 I t y �n+C / /k" Zip 225' 7 City L rvZ�� • "State i Daytime Phone(Y3Y) S7I 5"CV ar E-mail 4/#i i44,,,qqn 1 ..'e oat *When applications and plans are'reviewed, but not approved, and a response to comments is n'ot 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 a,.��(/^)� FWPO# C� 2�/ // Q Fee Amount$9100 Date Paid/v' /v By who? / `' ;I/ Receipt tl //,?— /Lkif /7;l / By:7161 7�F� 7/1/14, Revised: 7/10/14, 1/7/14 Page 2 of 2 Virginia Stormwater Management Program (VSMP) 0.11 Application for Albemarle County 11/" Project Name: ANKLEL j4 (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ® No 0 Is this a revision or resubmission for review? Yes 0 No 0 County File Number: WPO2017-23 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. ® A. Signature of the Property Owner for each parcel: (Required with every submission or revision,NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 42-26A,A3,A4, Oaklei.h Albemarle LLC 2 'ce" l$ Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 42-26A5,A6,A8 Oakleigh Albemarle LLC �.� 64.4•/Y Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 42-26A7 The Blake of Charlottesville LLCG2 2-D'e5 Tax Map&Parcel Print Name of Property Owner Signature of Owfier Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name George Ray;Oakleigh Albemarle Address 690 Berkmar Circle City Charlottesville State VA Zip 22901 Daytime Phone(434) 242-3527 E-mail geogerayjr@gmail.com 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of 2 B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 9.78 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 IFor(minor)amendments to an approved plan;$200 per review Variances;$150(per request) Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. 0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Alan Franklin, PE Address 427 Cranberry Lane City Crozet, VA 22932 State VA Zip 22932 Daytime Phone(434) 531-5544 E-mail alan@alanfranklinpe.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY �{ WPO# �OI 1,13R°1 2 -�j/� Fee Amount$ �l) (56 Date Paid � ' ° By who? �LI(11 �� Lott 1 Receipt# L l J R� Ck# By:3 , I a 21 C/1' 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2