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Dane Count , For Office Use Only—Revised 03.21.2016 <br /> Erosion Control Permit PermifNuriiber: ,ECoOI( -p4�la <br /> Application Application Received By: \Vat Date: 0 5/1e0 <br /> (Application must be made in person. Application Approved By: Date: <br /> Incomplete applications will not be accepted.) <br /> Associated Permits: <br /> Blackhawk Ski Club West Chalet p�"`�� Z <br /> Project Name: Applicant Information(Individual making in-person application) <br /> Landowner Name(s): Blackhawk Ski Club Applicant Name:Daniel Osborne <br /> Landowner Address: 10222 Blackhawk Rd Applicant Address: 6163 Reuter Rd <br /> Mazomanie, WI 53560 <br /> Landowner Phone: ( 608 ) 220-6947 Applicant Phone: ( 608 ) 220-6947 <br /> LandownerE-mail:djomakesnowl @gmail.com ApplicantE-mail:djomakesnowl @gmail .com <br /> Name and company of engineer/consultant who prepared the plans: BHSC <br /> Type of Permit: ppg Erosion Control _ (--I" Shoreland E rosion Control <br /> (check only one) (EC) (SE) <br /> Municipality:Town of Middleton: Section;0 . Quarter NE _ Parcel#:0708-171-9000-6 <br /> Fee Calculation(all projects must include disturbed area and new impervious:area) - <br /> Total Disturbed Area 0'. U.-� ft z$0.0051ft =$ 34 . 00 <br /> Total New Impervious Area 6` 241 0 0 ft2 <br /> (includes gravel) � <br /> Total Redevelopment Impervious Area - Q- J <br /> DE--- - 1 110 0 ft <br /> (includes gravel) <br /> Base Fee: Erosion Control(EC) $200 OR Shoreland Erosion Control(SE)$400 Base Fee=$200 . 00 <br /> ID Check box to apply$200 base fee for Shoreland Erosion Control <br /> (SE)projects meeting criteria in s.11.05(2)(c) Total Fee=$2 3 4 ' 0 0 <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 /> - <br /> Applicant Signature: Date: <br /> Der. o4c—c,) 4, 1 • <br /> If the person submitting the applica ion is not the landowner,a notarr}eal statement authorizing the applicant to ac 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 />