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DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP ° 3■ S 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 /> ` i1A 4 !�EAR i 0.4-1L-> lea La k-► • vI SE <br /> Number Road Town Sec 1/4 1/4 <br /> 5 4 �sZ.ssso2 P 1 <br /> Lot Block Subdivision or C.S.M. Number Zone <br /> PROPOSED WORK: BUILDING: FLOOD DISTRICT: AREA: <br /> Subdivision New General FP X 5° x ICocO <br /> Filling Addition Regional FF Square feet 20O0 <br /> Grading Alteration Regional FW RFE g 1-11 USGS <br /> Mineral removal Moving Top of fill 3`t$ USGS <br /> Dredging Z.P.# FIRM ZONE Cost 10 1 ooO <br /> Owner CONTRACTOR/BUILDER <br /> t-1,-11-AS - <br /> rn ∎5 ; W 5-51 <br /> Signed: (Owner/Agent) Date <br /> Pt issued Permit denied Reason <br /> Fee $ V3() By: C --� Date 5-2-1 -c>% <br /> Inspection record: <br /> By: Date C of C issued By: <br /> Plans prepared by «V P,r., V-)---1t>NN--IVzn\.--sC, Date ,6,. .�2cA Zce, <br /> Land Surveyor/Engineer/Architect <br /> Sent to DNR District Main Office By <br /> Other information vuv <br /> �`P� SEZZ0(D22-Gcj1 G <br /> CAC AA11 X117[]\ <br />