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Dane County For Office Use Only-Revised 01.08.2014 <br /> Erosion Control Permit Permit Number: <br /> Application Application Received By: Date; <br /> (Application must be made in person. Application Approved By: Date: <br /> Incomplete applications will not be accepted.) <br /> Associated Permits: <br /> Project Name: 2766 Tower Road Applicant Information(Individual making in-person application) <br /> Landowner Name(s): Justin Minor Applicant Name: <br /> Landowner Address: 2766 Tower Road Applicant Address: <br /> McFarland, WI 53558 <br /> Landowner Phone: Applicant Phone: <br /> Landowner E-mail: minor]@mail . com Applicant E-mail: <br /> Name and company of engineer/consultant who prepared the plans: Ryan Quam, Quam Engineering, LLC <br /> Type of Permit: ❑ Erosion Control 171 ShQreland Erosion Control <br /> (check only one) (EC) tv—'(Se) <br /> Municipality:Town of Dunn Section;9 Quarter:Na .Parcel#: 0610-093-0820-0 <br /> Fee Calculation(all projects must include disturbed area and new impervious area) <br /> Total Disturbed Area 3 , 250 ft2 x$0.005/ft2 =$ 16 . 25 <br /> Total New Impervious Area 46 5 _, ft2 <br /> (includes gravel) <br /> Total Redevelopment Impervious Area 121 ft2 <br /> (includes gravel) <br /> Base Fee:Erosion Control(EC) $200 OR Shoreland Erosion Control(SE)$400 Base Fee=$ 4 0 0 . 0 0 <br /> ❑Check box to apply$200 base fee for Shoreland Erosion Control <br /> (SE)projects meeting criteria in s. 11.05(2)(c) Total Fee=$ 416 . 2 5 <br /> Notes: <br /> 1.All requirements included in this application correspond to the requirements set forth in Chapters 11 and/or 14 of the Dane <br /> County Code of Ordinances. <br /> 2.By submitting this application, permittee and landowner permit Dane County staff to enter project property for inspection and/or <br /> curative action(s. 11.05(5)(a)3 or 14.49(4)(c)). <br /> 3. Late filing fee: The permit fee shall be doubled where work has begun before a permit has been obtained(s. 11.50(7)or <br /> 14.55(2Xb)). <br /> Applicant Signature: Date: <br /> If the person submitting the application is not the landowner,a notarized statement authorizing the applicant to act as the <br /> landowner's agent must be attached. <br /> This application must be submitted in person (M-F, 8 A.M. —4 P.M.) <br /> with two copies of all permit materials & fees to: <br /> Water Resource Engineering Division, 5201 Fen Oak Drive, Room 208, Madison, WI 53718 <br /> Exhibit#1(a) <br />