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ty _ �I '"'. DANE COUNTY <br /> Dan ; o n `,∎� � Land Conservation Department <br /> Erosi • n ontrol & Stormwater ANGELA MAYR <br /> CONSERVATION SPECIALIST <br /> Mana • e ent Permit Application Lyman F.Anderson Agriculture&Conservation Center <br /> (Incomplete applications will not be accepted) <br /> 1 Fen Oak Ct.,Rm.208 PH: 608/224-3737 <br /> Madison,WI 53718-8812 FAX: 608/224-3745 <br /> mayr@co.dane.wi.us TTY: 608/224-3703 <br /> Project Name: Garage Applican <br /> Landowner Name(s): Daniel Pietrzykowski Applicant Name: Daniel Pietrzykowski <br /> Landowner Address: 7811 Manistee Ct. Applicant address: 7811 Manistee Ct. <br /> Verona, WI 53593 Verona, WI 53593 <br /> Landowner Phone: (608) 237-1714 applicant Phone: (608) 237-1714 <br /> dpietrzykowski @yahoo.Com dpietrzykowski @yahoo.com Landowner E-mail: Applicant <br /> Name and company of engineer/consultant who prepared the plans: n/a <br /> Type of Permit: I Erosion Control Only I Stormwater Management Only Erosion Control&Stormwater <br /> (check only one) (EC) (SM) Management(ES) <br /> ivl Shoreland Erosion Control Only _; Shoreland Erosion Control& <br /> (SE) Stormwater Management(SS) <br /> Municipality: Town of Middleton Section:30 Quarter', NW_ Parcel#: 038/0708-302-0253-0 <br /> Fee Calculation(all projects must include disturbed area and new impervious,even if not subject to fee as noted by brackets) <br /> Total Disturbed Area... EC,ES,SE,SS ...: 1,000 ft2x$0.005/ft2 =$ 5.00 <br /> Total New Impervious...[ES,SM,SS] ft2x$0.010/ft2 =$ <br /> (includes gravel) <br /> Total Redevelopment Impervious...[ES,SM,SS] ft2 x$0.005/ft2 =$ <br /> (includes gravel) <br /> Base Fee: $200- EC or SE meeting criteria in Ch. 11.05(2)(c);$400 ES,SM, SE, or SS Base Fee=$ 200.00 <br /> Total Fee=$ 205.00 <br /> Notes: <br /> 1. Be sure to clearly indicate the extent(limits)and size (ft2)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 /> • '—pection and/or <br /> DATE -1 19-9 lD `1 No. 422737 09 <br /> i 2 ed statement <br /> RECEIVED FROM _ b L.4 - • /t& <br /> W '0 d VAA 1—t-a c I Lcv-5 4 aa/cozDOLLARS <br /> ()FOR RENT G� J <br /> ( FOR <br /> IA( � ACCOUNT OCASH <br /> F�ML� TO .M <br /> PAYMENT cgCHEcie t m �� <br /> CeMONEY Y l a <br /> BAL.DUE OORDER BY 1182 ' WI <br />