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• DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP 55\`l C <br /> The undersigned hereby makes application for a permit to develop in a flood plain. The work <br /> to be performed, including flood protection works, is as described below and in attachments <br /> hereto. The undersigned agrees that all such work shall be done in accordance with the req- <br /> uirements of the Dane County Flood Plain Zoning Ordinance and with all other applicable <br /> County Ordinances and the laws and regulations of the State of Wisconsin. <br /> LOCATION: <br /> 3so-39A- <br /> 35S - 35l Lp\1&E S1-\oe-E- N- ,14_\vE. A,1--h.10 ti aS ►Sv'J S • <br /> Number Road 1? <br /> c Town Sec 1/4 1/4 <br /> Etc& 'cO'3 1J0Qc.A 1 A fZK <br /> Lot Block Subdivision or C.S.M. Number Zone <br /> PROPOSED WORK: BUILDING: FLOOD DISTRICT: AREA: <br /> Subdivision New General FP to o x 20O <br /> Filling XC Addition Regional FF X Square feet acs ©o o <br /> Grading Alteration Regional FW RFE "lib LA USGS <br /> Mineral removal Moving 7< Top of fill 7 ,5.ZUSGS <br /> Dredging Z.P.# FIRM ZONE AC Cost A10,0o0 <br /> Owner CONTRACTOR/BUILDER <br /> ao ►AR2 - 7..'►ELiosK► --?w`A1Dt. -- Ckv) 0C.,%ti--M- t,6 <br /> 1---V; c13 L-AP-Sclo c- t..1c■-k fRtz <br /> in j aru- , \iN( 53S5 iS <br /> Signed: (Owner/Agent) Date <br /> Permit issued `/- Permit denied Reason <br /> Fee $ 15o By: /iiir Date q Z r)14 <br /> Inspection record: <br /> By: Date C of C issued By: <br /> Plans prepared by Date <br /> Land Surveyor/Engineer/Architect <br /> Sent to DNR District Main Office By <br /> Other information <br /> 545-44(12/781 <br />