HomeMy WebLinkAboutWPO201500078 Preconstruction Form WPO VSMP 2018-08-06 • 1
Request for Pre-construction Meeting and Grading Permit ® ice
from Albemarle County
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Approved Plan Number: WPO- 7_015 ON)?gj
Approved Plan Name:
pp N ortrN ��^ITE /*DD T 54-2/1/-(E. 5 �. 7r1 ovi PM07154723
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: 21b/I3
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: AL R. O H Lr
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State Certification Number: 144 Q 5 b I
Address ZLf1Ij OLD 1 ?LA-0
City (LW LurraiJtu 1` State VA Zip 720163
Daytime Phone(1-31) 9 68 - 52H E-mail fkll/0. lL0'FILUc.-M. ^e ff & . CCS
Primary Contractor:
Print Name I-Ai c 2_ C :,r,Ds-rink Y).-S (O4P 1-1
Address 2H43 b ni_o f 1\..J
City ( 2SLOTT V1 l State VA Zip 22%3
Daytime Phone 0-1-6t-i) 2.56-—0022 E-mail ?.ReIN s3 t01- . Cc34\
Permit Issuance and First Year Maintenance Fees: (Request inusi 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
$748.00
•• - than 50 —$790.0u
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
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Person(s) to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
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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?
7/1/14,Revised: 8/29/14 Page 2 of 3
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} Fee Received
RECEIVED
Received Date AUG 0 9 2010
§ifil COMMUNITY
Received By DEVELOPMENT
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