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•Dane County <br /> Erosion Control and Stormwater P�r'Y" u"'ae �Glpg 0216 <br /> Management Permit Application Date:*8/5/20%r <br /> Project Name: Zweifel Residence Applicant Information(individual making in-person application) <br /> Name(s): Brentt Zweifel Name(s): Brain Zweifel <br /> Address: 1719 Fritz Rd Address: 552 Toepfer Ave <br /> Verona,WI 53593 Madison,WI 53711 <br /> Phone: (608) 845-7803 Fax: Phone: (608)279-7803 Fax: <br /> e-mail bwzweif @tds.net e-mail zweif @hotmail.com <br /> Name and company of engineer/consultant who prepared the plans: <br /> Type of Permit: <br /> 0 Erosion Control Only ❑ Erosion Control and Stormwater Management ❑ Stormwater Management Only <br /> (EC) (ES) (SM) <br /> ❑ Redevelopment ❑ Shoreland Erosion Control Only ❑ Shoreland Erosion Control and <br /> (RD) (SE) Stormwater Management(SS) <br /> Municipality: Town of Verona Section: 31 Quarter: SE Parcel# 0608-314-8860-0 <br /> Fee Calculation (all projects must include disturbed area and new impervious,even if not subject to fees as noted by brackets) <br /> Total Disturbed Area...[EC,ES,RD,SE,SS] 0 sq.ft. x $0.0040/sq.ft. = $0.00 <br /> Total New Impervious...[ES,SM,RD,SS] 0 sq.ft. x $0.0050/sq.ft. = <br /> (includes gravel) <br /> Total Redevelopment Impervious...[RD] 0 sq.ft. x $0.0025/sq.ft. = <br /> (includes gravel) <br /> Base Fee= $200.00 <br /> Base Fee: EC,ES,SM, or RD($200);SE or SS with new or replacement structure($400); <br /> SE or SS without new or replacement structure($200);or SE permit with P.E>waiver under <br /> DCCO 11.o5(2)(b)($50)[subtract PRL fee($50)if application includes PRL and receipt] Total Permit Fee = $200.00 <br /> Notes: <br /> 1. Be sure to clearly indicate the extent(limits)and si .,t"2) of all disturbed and impervious areas on your plan. <br /> 2. All requirements inc:::ded 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, permitte and landowner permit Dane County Staff to enter project property for inspection <br /> and/or curative action (s. 14.49(4)c or 11.05(5)(a)3 DC Code of Ordinances). <br /> Applicant Signature: Date: <br /> Permit Received By: Date: <br /> Permit Reviewed By Date: <br /> This Application must be &LIbmitted in person M-F, 8A.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 /> 8/5/2008 12:40:27 PM;jrt2 <br />