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HomeMy WebLinkAboutWPO201800011 Preconstruction Form WPO VSMP 2018-03-19 Request for Pre-construction Meeting and Grading Permit 4of A,�m�ii . `T©= from Albemarle County '4460 Approved Plan Number: WPO- 0,/6/31- Doe// Approved Plan Name: 640 46;1/2_ ,Fits// Loss (Plans must be approved prior to a pre-construction meeting.) Bond approved date: j//9/ /� (Bonds must be approved and posted prior to a pre-construction meeting or permit.) Responsible Land Disturber: Print Name: a1112 State Certification Number: ��� "73j i Address �, 0e x- 6i 5 City ,//;1 1e7-7 S /L&E State v Zip 69 94, Daytime Phone 0/, c,?1/ `033 E-mail !d'///, 0-61/' ciny/Qb4(Ilder"S,e/77 Primary Contractor: `J Print Name &i7/ Ze)re,/6/U5f3 J J,(,/ Address -& 3 S if)/ /66 /AA.) City �,r 4e2,e2 T j0« State 1/ii? Zip c?c79! Daytime Phone(0) "23—334 ' E-mail A. 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 Person(s) to attend the Pre-construction Meeting: Names(type or print) Firm Contact Number or email h 2 (,/e/ " c; i/�,�� ,�sfs y.3yV The second part of the application fee is required to be paid with this request. This fee amount is; FOR OFFICE USE ONLY Permit Issued Date By who? ince. � , ;'v i P 7/1/14,Revised: 8/29/14 Page 2 of 3