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DANE COUNTY Zoning Division <br /> PLANNING DEVELOPMENT Room 116, City-County Building <br /> 210 Martin Luther King Jr. Blvd. <br /> cos Madison, Wisconsin 53703-3342 <br /> Floodplain Development Application Fax: (6 8) 267-1 66 <br /> 540 <br /> Items required to be submitted with application: <br /> o Site Development Plans <br /> Plans shall include scaled drawings of existing topography of the area and proposed final grades of <br /> it <br /> development. All topographical opographical information shall be in NAVD 1988 and be referenced to a known <br /> benchmark. The plan shall show all existing and proposed building footprints and elevations of lowest <br /> floor elevations. The plans shall include dimensions of ditches, culverts,, or other structures existing or <br /> proposed. All plans shall be stamped and signed by a professional engineer or architect. <br /> o Engineering Analysis <br /> The analysis shall include calculations or modeling that shows that the development will not obstruct <br /> flow or will not increase the floodwater elevation 0.01 of a foot or more. All calculations shall be <br /> stamped and signed by a professional engineer or architect. <br /> Owners Name ° .Q f S$-€t/^ Contractor's Name <br /> J <br /> Address Pr ISS 4 dl Address <br /> Phone V (21' t rtc <br /> Phone <br /> 6cA, L $ <br /> Email Email <br /> Parcel numbers affected: 0 So - // I - 9 S /1 - G Town: Pr,'LwtoSt Section: /I <br /> Property Address: <br /> FEMA Panel Map: S'S Q G Floodplain District: A Flood Elevation: <br /> €'o,rs�atie l>h s f <br /> NtT,y 7646 <br /> Scope of work: (Describe development in detail) j FP Ror 0/4%e no3 <br /> I authorize that I am the owner or have permission to act on behalf of the owner of the property. <br /> Submitted By: Date: <br /> it <br />