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Dane County Land Conservation Division <br /> DINAP - "DO I NEED A PERMIT" <br /> General Information: <br /> Caller/Contact: Jessica Grosso Phone#: 577-3695 <br /> Landowner: Donald Derr Phone#: <br /> Contact email: jessgrosso @yahoo.com <br /> Project Address: Lot 2, CSM 12273 <br /> Location: Township: York Sec: 5 '/4 SW <br /> Parcel#: 0912-053-8220-0 <br /> Project Description: Construct a single family residence. <br /> Planned Size of Disturbance: ft2 Planned Size of New Impervious: ft2 <br /> Land Conservation Division Response : <br /> Based on information above the project: DOES* 1/IDOES NOT require a permit <br /> Determination Made By: ❑JAH ❑JAS LJDB FJRT ❑RLS <br /> *Type of permit required: EC DES I SM ❑SE SS <br /> Disturbance >4000 ft2 ❑Slopes> 12% ❑Excavate/Fill>400 yds3 <br /> IDisturbing 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: Pond located to the northeast of the proposed residence in <br /> non-navigable per DNR maps. Single family residences are exempt from <br /> erosion control permit requirements under 14.47(2)(a). <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 />