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DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP 5-2-1-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 /> 3% L, & SherL Pr Alb I'D K--) 4Si Sc MuJ <br /> Nuum er Road Town Sec 1/4 1/4 <br /> 'Ib7 <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 ic,v0C> (4- <br /> Grading Alteration Regional FW RFE USGS <br /> Mineral removal Moving Top of fill USGS <br /> Dredging Z.P.# FIRM ZONE Cost <br /> Owner CONTRACTOR/BUILDER <br /> • <br /> 3? C�'�1 e'- c; \ 1 <br /> X1,1 ou cis 1 L 6 oO ��- <br /> Signed: (Owner/Agent) Date <br /> Permit issued /012_1106 Permit denied Reason <br /> Fee $ /�0° By: Si: 1 0 r Sc. iiroeC-k"e.v f kcl Date 10 1Ll 10 <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 />