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&A* -d2 <br /> S ' � � 3 <br /> Dane County Land Conservation Division <br /> DINAP - "Do I NEED A PERMIT" <br /> General Information: <br /> Caller/Contact: Kurt Holler- Holler & Sons Phone#: (608) 767-3910/ ? <br /> Landowner: Adrian & Kimberly Smith Phone#: $L/5 - (p . -5 7 <br /> Contact email: <br /> Project Address: 2349 Spring Rose Rd., Verona, WI 53593 <br /> Location: Township: Springdale Sec: 24 1/4 SE of NE <br /> Parcel#: 0607-241 -9980-0 <br /> Project Description: 24' x 34' Garage addition to rear of existing residence, 2nd_ <br /> story addition above existing residence, driveway extension and apron. <br /> Planned Size of Disturbance: <2,000 ft2 Planned Size of New Impervious: 1185 ft2 <br /> Land Conservation Division Response : <br /> Based on information above the project: ❑DOES* EIDOES NOT require a permit <br /> Determination Made By: ❑JAH OJAS ❑JDB ❑JRT ❑RLS <br /> *Type of permit required: EEC ❑ES ❑SM ESE Ess <br /> ❑Disturbance >4000 ft2 ❑Slopes> 12% ❑Excavate/Fill>400 yds3 <br /> ❑Disturbing 100' of ditch/channel 0125'New road/driveway ❑Shoreland Zone disturbance <br /> ❑Addition of 20,000 ft2 New Imp. ❑Subdivision Plat/CSM ❑Other: <br /> Basis for Determination: Not in shoreland Zone, disturbed area <4,000 sq.ft., <br /> slopeaprox. 9.5% (<12%), no other erosion control permit criteria met. <br /> Permit determination based upon information provided by caller/landowner. Changes in project size, scope or <br /> location may trigger changes to permit requirements. It is the responsibility of the owner to ensure all required <br /> permits have been obtained prior to commencing work. <br />