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For Office Use Only <br /> Erosion Control Permit <br /> Simplified Application Checklist Permit Number: <br /> Date: <br /> Project Name: Tom Bug-lass House <br /> Plan Requirements X Location of Information: <br /> Page Number or Attachment <br /> 1. Narrative describing the proposed project Driveway to a new small house - 1200 sq ft, <br /> garage 900 sq. ft. <br /> 2. * Site plan (of known scale that includes:property lines,disturbed area limits, <br /> impervious area limits(existing and proposed), natural and artificial water <br /> features, 100-yr flood plain,delineated wetland boundaries,location of all V <br /> proposed erosion control practices) <br /> NOTE: Grading within 5'of the property line requires department approval <br /> 3. * Contours (existing and proposed) <br /> V <br /> 4. ' Watershed size for each drainage area <br /> (include area draining to the site and within project boundaries) V <br /> 5, Tracking control Exisitng gravel driveway (appror. 75' of driveway <br /> (provisions to prevent mud-tracking onto public streets and roads during already installed) <br /> construction,e.g.tracking pad or existing gravel drive) <br /> 6. Sediment control practices to protect stormwater facilities or area down slope of home and driveway in permanent <br /> storm sewer inlets, existing and proposed, on or adjacent to the V grass <br /> site(e.g. inlet protection or stone weeper) <br /> 7. Proposed erosion control practices Grass buffer, most areas will be covered with <br /> (list of erosion control practices) grave' within 7 days <br /> V <br /> • <br /> 8. Proposed start date As soon as possible <br /> (date for installation of all erosion control practices and start of land disturbing ✓ <br /> activity) <br /> 9. Proposed stabilization date November 15th, 2016 <br /> (date for placement of seed&mulch,sod or permanent surfacing) V <br /> 10. Culvert sizes 29" existing <br /> (existing and proposed culverts on or adjacent to the site) ✓ <br /> 11. Any other information necessary to reasonably determine the see maps <br /> location, nature and condition of any physical or environmental ✓ <br /> features of the site <br /> Note: Any proposed changes to the erosion control plan must be submitted and approved prior to <br /> implementation. The permit will expire on the stabilization date indicated in the plan (see checklist item #9). <br /> * The following Dane County websites may be useful in addressing the above checklist items: <br /> http://accessdane.co.dane.wi.us/html/public.asp <br /> https://dcimaPaPOs.countvofdane.com/lwrviewer/ <br /> https://wred-Iwrd.cou ntvofd a ne.com/ <br /> Revised 03.21.2016 <br />