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Dane County <br /> eZOOPI - 0 1 <br /> S•V rostr <br /> Erosion Control & Stormwater <br /> Management Permit Application q. s: <br /> (Incomplete applications will not be accepted) <br /> Project Name: Bush Residential Site Applicant Infulwauvri irnaiviauai making in-person application) <br /> Landowner Name(s): Scott & Jennifer Bush Applicant Name:E.W. Olson Homes Attn: Eric Olson <br /> Landowner Address: 90 N Hay Hollow Rd. Applicant Address:301 Corbin Dr. <br /> Mt. Horeb, WI 53572 Bameveld, WI 53707 <br /> Landowner Phone: 608-523-1270 Applicant Phone:608-924-1900 <br /> Landowner E-mail: Applicant E-mail: eric @ewolsonhomes.com <br /> Name and company of engineer/consultant who prepared the plans: Grant Pokos, JSD Professional Services, Inc <br /> Type of Permit: Erosion Control Only Stormwater Management Only Erosion Control&Stormwater <br /> (check only one) (EC) 0 (SM Management(ES) <br /> © Shoreland Erosion Control Only Shoreland Erosion Control& <br /> (SE) F,; StormwaterManagement(SS) <br /> b Town of Perry ri SW. Parcel#: 044/0506-333-9570-9 <br /> municipality: � `Sedw�3 �� .. ;Quarter <br /> .at a hyJ S X t�YZ <br /> Fee Calculation(all projects must Include disturbed area end new impel vious,even if not subject to fee as noted by brackets) <br /> .1•'(a&5::* <br /> Total Disturbed Area...[EC,ES,SE,SS] t ' `` fi;,8,800 1 ft2 x$0.00 =$ 44.00 <br /> Total New Impervious...[ES,SM,SS] 495 t ft2 x$0.01 o/ft2=$ 4.95 <br /> (includes gravel) <br /> Total Redevelopment Impervious...(ES,SMSSj_..,,. ?• ft2 x$0.005/ft2 =$ <br /> (includes gravel) <br /> Base Fee:$200-EC or SE meeting criteria in Ch. 1.1.060j4$400 ES'SM,SE,or SS Base Fee=$ 400.00 <br /> Total Fee=$ 448.95 <br /> Notes: <br /> 1.Be sure to dearly 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 /> 3.By submitting this application,permittee and landowner permit Dane County staff to enter project property for inspection and/or <br /> curative action(s. 14.49(4)c or 11.05(5Xa)3 DC Code of Ordinances) <br /> Applicant Signature: Date: <br /> If the person applying(submitting the application in-person,at the counter)Is not the landowner,a notarized statement <br /> authorizing the applicant to act as the landowner's agent must be attached <br /> Permit Received by: Date: <br /> Permit Reviewed by: Date: <br /> This application must be submitted in person M-F, 8 A.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 />