Rev 12/2020 Page 1 of 1
Section I. Current Construction Activity Operator/Permittee Information. Operator information as it appears on the current,
active permit coverage (if applicable) or on Hanover County Building Permit.
Construction Activity
Operator Name:
Contact Person:
City, State and Zip Code:
Phone Number:
Primary Email:
CC Email:
Section II. Construction Activity Location Information. Locational information regarding the construction activity site.
Related Permit /
Application Number:
Construction Activity
Name / Location:
Section II. Fee. The fee is calculated based on the type of land disturbing activity. From the Fee Schedule.
Amount of fee submitted:
Section VI. Instructions. Fees are required and must be paid when applications for land disturbing activities are submitted.
Applications are considered incomplete if the proper fee is not paid in full and will not be processed until the fee is received. The fee
schedule is included with this form.
Please submit this form to: Town of Ashland
PO Box 1600
Ashland VA 23005
Fee Schedule. The fee for local land disturbing activities not subject to General Permit coverage, is as follows:
Chesapeake Bay Preservation Act Land-Disturbing Activity; sites within designated areas of Chesapeake
Bay Act localities with land-disturbance acreage equal to or greater than 2,500 square feet and less than
one acre
General / Stormwater Management Small Construction Activity/Chesapeake Bay Preservation Act Land-
Disturbing Activity/Land Clearing (Single-family detached residential structures within a common plan of
development or sale with land-disturbance acreage less than 5 acres)
Single-family home (not part of larger subdivision or plan of development with an approved BMP and
stormwater management plan)
New accessory buildings/facilities over 50 square feet requiring a building permit, including additions,
garages, accessory buildings, decks, patios, pools, driveways, and walkways (excluding ADA ramps)
$1/sq. ft. of new
impervious area
Small subdivision of 5 lots or less $5,000 per lot