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Dane County - 7 ,t , <br /> Erosion Control and Stormwater <br /> Management Permit Application ` xp <br /> Project Name: Blake House Applicant Information(individual making in-person application) <br /> Name(s): Mike Blake and Sally Blake Name(s): Legendary Homes <br /> Address: 927 Harrington Dr Address: 8000 Excelsior Dr <br /> Madison,WI 53718 Madison,WI 53717 <br /> Phone: (608)695-6332 Fax: Phone: (608)826-5300 Fax: <br /> e-mail sallyruth @gmail.com e-mail tony@legendarybuilt.com <br /> Name and company of engineer/consultant who prepared the plans: <br /> Type of Permit: <br /> 0 Erosion Control Only ❑ Erosion Control and Stormwater Management ❑ Stormwater Management Only <br /> (EC) (ES) (SM) <br /> ❑ Redevelopment ❑ Shoreland Erosion Control Only ❑ Shoreland Erosion Control and <br /> (RD) (SE) Stormwater Management(SS) <br /> Municipality: Town of Cottage Grove Section: 03 Quarter SW Parcel# 0711-033-8430-8 <br /> Fee Calculation (all projects must Include disturbed area and new Impervious,even if not subject to fees as noted by brackets) <br /> Total Disturbed Area...[EC,ES,RD,SE,SS] 47,230 $236.15 <br /> Total New Impervious...[ES,SM,RD,SS] 10,900 <br /> (includes gravel) <br /> Total Redevelopment Impervious...[RD] 0 <br /> (includes gravel) <br /> Base Fee= $200.00 <br /> Base Fee:EC,ES,SM,or RD($200);SE or SS with new or replacement structure($400); <br /> SE or SS without new or replacement structure($200);or SE permit with P.E>waiver under <br /> DCCO 11.05(2)(b)($50)[subtract PRL fee($50)if application includes PRL and receipt] Total Permit Fee= $436.15 <br /> Notes: <br /> 1.Be sure to clearly indicate the extent(limits)and size(ft"2)of all disturbed and impervious areas on your plan. <br /> 2.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 /> 3.By submitting this application,permitte and landowner permit Dane County Staff to enter project property for inspection <br /> and/or curative action(s. 14.49(4)c or 11.05(5)(a)3 DC Code of Ordinances). <br /> Applicant Signature: Date: <br /> Permit Received By: Date: <br /> Permit Reviewed By Date: <br /> This Application must be submitted in person M-F, 8A.M. - 4 P.M., <br /> with two copies of all permit materials to: <br /> Dane County Land Conservation, 1 Fen Oak Ct, Room 208, Madison, WI <br /> 12/16/201311:34:50 AM;jrt2 <br />