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411_5 <br /> DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP 53.3 <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: k0 f ^ II <br /> Number Road Town Sec 1/4 1/4 <br /> 3S 7 /3r A ? v/�- <br /> Lot Block Subdivision or C.S.M. Number Zone <br /> PROPOSED WORK: BUILDING: FLOOD DISTRICT: AREA: <br /> Subdivision New General FP x <br /> Filling Addition Regional FF Square feet <br /> Grading Alteration V Regional FW RFE USGS <br /> Mineral removal Moving Top of fill USGS <br /> Dredging Z.P.# Zoo°bS7( FIRM ZONE Cost <br /> Owner ( CONTRACTOR/BUILDER <br /> Tack'e-v c L <br /> 38 Li 1.1 r <br /> Ctn ► 0 , /85J <br /> Signed: (Owner/Agent) Date <br /> Permit issued ) 11 Permit denied Reason <br /> Fee $ (ZS'- Oo By: CLo /"1— jil✓v -e°c,kyeAllol!`".-- Date 10((i/ S <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(1 2/78) <br />