Laserfiche WebLink
Dane County 4 ° �seon ' <br /> Erosion Control & Stormwater * A� � 4 X " ' - <br /> - s Management Permit Application 1 �*z ,v;� i ° ' <br /> (Incomplete applications will not be accepted) `° " " " <br /> c D <br /> Project Name:5033 Saint Cyr Road Applicant Information(Individual making in-person application) <br /> Landowner Name(s):Gary and Barbara Tarpley Applicant Name:Rick Schoenemann <br /> Landowner Address: 5033 St. Cyr Road Applicant Address:32375 H WY 130 <br /> Middleton, WI 53562 Lone Rock, WI 53556 <br /> Landowner Phone: 608-798-0156 Applicant Phone:608-255-8977 <br /> Landowner E-mail: Applicant E-mail: <br /> Name and company of engineer/consultant who prepared the plans: Calkins Engineering, LLC <br /> Type of Permit: Erosion Control Only Erosion Control&Stormwater Management Stormwater Management Only <br /> (check only one) ❑ (EC) (ES) (SM) <br /> • Redevelopment Shoreland Erosion Control Only Shoreland Erosion Control& <br /> - (RD) © (SE) .: Stormwater Management(SS) <br /> Municipality:Town of Westport Section:: 6 NE 'A of the SE %.Parcel#:'4...d 7 0 R—d 6 T /64-1 <br /> Fee Calculation(all projects must include disturbed area and new..,impervious,evenif not subject to fee as noted by brackets) <br /> Total Disturbed Area...[EC,ES,RD,SE,SS] ..... ..... 565 ft2x$0.0040/ft2=$ 2.26 <br /> Total New Impervious...[ES,SM,RD,SS]........ ....... ........... ft2 x$0.0050/ft2=$ <br /> (includes gravel) <br /> Total Redevelopment Impervious...[RD]....... ................................... ft2 x$0.0025/ft2=$ <br /> (includes gravel) <br /> Base Fee:EC,ES,SM,or RD($200);SE or SS with new or replacement structure($400); Base Fee=$ 400.00 <br /> SE or SS without new or replacement structure($200);or SE permit with P.E.waiver under <br /> DCCO 11.05(2)(b)($50)[subtract PRL fee($50)if application includes PRL and receipt] Total Fee=$ 402.26 <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: i ./ i ....... .-��-... 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: 6 r-}- Date: 7 /r 7 / 06 <br /> Permit Reviewed by: ``JJ 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 /> I 1 - ,,"-- 7. __/ <br /> 41 r 7_,N, ,.:isuciov--Auf, <br /> •• •• <br />