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Dane County Land Conservation Division <br /> DINAP - "Do I NEED A PERMIT" <br /> General Information: <br /> Caller/Contact: Pat (Cornerstone Designs) Phone#: 608.225.2400 <br /> Landowner: David and Patricia Gervasi Phone#: <br /> Contact email: pat@ cornerstonedesignsofmadison.com <br /> Project Address: 3850 Swoboda Dr <br /> Location: Township: Middleton Sec: 19 '/4 SE <br /> Parcel#: 0708-194-2125-3 <br /> Project Description: patio & gazebo <br /> Planned Size of Disturbance: ^'1500 ft2 Planned Size of New Impervious: <1000 ft2 <br /> Land Conservation Division Response : <br /> Based on information above the project: ❑DOES* QDOES NOT require a permit <br /> Determination Made By: ❑✓JAH ❑JAS ❑JDB ❑JRT ❑RLS <br /> *Type of permit required: EEC EES ESM ESE ❑SS <br /> ❑Disturbance >4000 ft2 ❑Slopes> 12% LExcavate/Fill>400 yds3 <br /> ❑Disturbing 100' of ditch/channel 0125' New road/driveway ❑Shoreland Zone disturbance <br /> ❑Addition of 20,000 ft2 New Imp. ❑Subdivision Plat/CSM ❑Other: <br /> Basis for Determination: <br /> The project is not in the shoreland zone and does not trigger Ch. 14 requirements <br /> Permit determination based upon information provided by caller/landowner. Changes in project size,scope or <br /> location may trigger changes to permit requirements. It is the responsibility of the owner to ensure all required <br /> permits have been obtained prior to commencing work. <br />