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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:Buchner Residence Applicant Information (Individual making in-person application) <br /> Landowner Name(s): Brandon&Tonya Buchner Applicant Name: Peter D Fortlaqe <br /> Landowner Address: 4138 Veith Ave . Applicant Address: 2801 International Lane <br /> Madison, WI 53704 Suite 101, Madison WI 53704 <br /> Landowner Phone: (608) 512-6052 Applicant Phone: (6 0 8) 250-9263 <br /> Landowner E-mail: tbuchnerl020 @gmail . com ApplicantE-mail: pfortlage @bse-inc .net <br /> Name and company of engineer/consultant who prepared the plans: Burse Surveying & Engineering, Inc . <br /> Type of Permit: Erosion Control Shoreland Erosion Control <br /> (check only one) (EC) v (SE) <br /> Municipality:Town of Vienna Sec ion: 3 6 • Quarter SW •Parcel#: 0909-363-6604-0 <br /> Fee Calculation(all projects must include disturbed area and new impervious area) <br /> Total Disturbed Area ....... .................. .....a 12 , 100 ' ft2 x$0.005/ft2 =$ 60 . 50 <br /> • <br /> ■ <br /> Total New Impervious Area ......... . 3 , 3'3 8 ft2 <br /> (includes gravel) <br /> Total Redevelopment Impervious Area ........ ... '"0 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$200 base fee for Shoreland Erosion Control <br /> (SE)projects meeting criteria in s. 11.05(2)(c) Total Fee=$ 4 6 0 . 5 0 <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(2)(b)). <br /> Applicant Signature: • Date: g%/s <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 />