Laserfiche WebLink
Dane County For Officer Use Only—Revised 03.21.2016 <br /> Erosion Control Permit Permit Number: C. ?DI - 01 70 <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: Ederer House Applicant Information(Individual making in-person application) <br /> Landowner Name(s): Mark & Monica Ederer Applicant Name: Mark & Monica Ederer <br /> Landowner Address: PO Box 91 Applicant Address: PO Box 91 <br /> Prairie du Sac, WI 53578 Prairie du Sac, WI 53578 <br /> Landowner Phone: ( 608 ) 438-7501 Applicant Phone: ( 608 ) 438-7501 <br /> Landowner E-mail: markederer @gmail . com Applicant E-mail:markederer @gmail . com <br /> Name and company of engineer/consultant who prepared the plans: Tomas Toro, Ramake r & Associates <br /> �_it � r <br /> Type of Permit: pu Erosion Control . '; ,art:. a I Shoreland Erosion Control <br /> (check only one) (EC) .:-4 '. (SE) <br /> f [ ♦A <br /> Municipality:Town of Roxbury Section: 10 Quarter:NW Parcel#: 0907-101-8710-1 <br /> Fee Calculation(all projects must include disturbed area and new impervious area) ' t; <br /> Total Disturbed Area 30 , 5 8 4 ft2 x$0.005/ft2 =$ 152 . 92 <br /> h:,:�, � =_.. 8 <br /> Total New Impervious Area "hrJ4T~r` , 618 ft z <br /> (includes gravel) f ws!- <br /> � c <br /> Total Redevelopment Impervious Area 0 ftz <br /> (includes gravel) -, <br /> Base Fee: Erosion Control(EC) $200 OR Shoreland Erosion Control(SE)$400 Base Fee=$ 200 . 00 <br /> ❑Check box to apply$200 base fee for Shoreland Erosion Control <br /> (SE)projects meeting criteria in s. 11.05(2)(c) Total Fee=$ 352 . 92 <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: 05/11/16 <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 />