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Dane County <br /> Erosion Control Permit PenuItNu n ° 44- Yatt: <br /> Application <br /> (Application must be made in person. Application Apovedy, -a. <br /> Incomplete applications will not be accepted) yF <br /> Associated Permits' <br /> Project Name:Hamilton Residence Applicant Information(Individual making in-person application) <br /> Landowner Name(s): Samuel and Abby Hamilton Applicant Name: <br /> Landowner Address: 606 Birchwood Trail Applicant Address: <br /> Mt Horeb WI 53772 <br /> Landowner Phone: Applicant Phone: <br /> Landowner E-mail: Applicant E-mail: <br /> Name and company of engineer/consultant who prepared the plans: Ryan Quam, Quam Engineering, LLC <br /> Type of Permit: r:71 Erosion Control Shoreland Erosion Control <br /> (check only one) (EC) <br /> Municipality:Town of Vermont • Seorti*14, Parcel#: 0 7 0 6-14 3-95 0 0-9 <br /> Fee Calculation(all projects must include dlstuv)md area and new lamaK0 area) :e. <br /> Total Disturbed Area ...................... ` : : - °7 5.;,00 0 x$0.005/ft2 =$ 375 . 00 <br /> Total New Impervious Area......................... .. 12(0 0 ft2 <br /> (indudes gravel) <br /> Total Redevelopment Impervious Area ...................:....... :.'.., .._ ' . ft2 <br /> (includes gravel) <br /> Base Fee:Erosion Control(EC) $200 OR Shoreland Erosion Control(SE)$400 Base Fee=$ 2 0 0 . 0 0 <br /> ❑Check box to apply$200 base fee for Shoreland Erosion Control <br /> (SE)projects meeting criteria in s.11.05(2)(c) Total Fee=$ 5 75 • 0 0 <br /> Notes: <br /> 1.All requirements included in this application corres and 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 lando er permit Dane County staff to enter project property for inspection and/or <br /> curative action(s. 11.05(5)(a)3 or 14.49(4Xc)). <br /> 3.Late filing fee: The permit fee shall be doubt=.: wh re work has begun before a permit has been obtained(s. 11.50(7)or <br /> 14.55(2)(b)). <br /> r <br /> Applicant Signature- / c Date: ?_/_/ fo <br /> If the person submitting application is not the andowner,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 copie of all permit materials &fees to: <br /> Water Resource Engineering Divisio , 5201 Fen Oak Drive, Room 208, Madison, WI 53718 <br />