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DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP S-2-11 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 /> 390 k%- $I c2 r Inh;o r\ Z 5E qui. <br /> Number Road Town Sec 1/4 1/4 <br /> fZ 1a,'�' <br /> Lot Block Subdivis4on or C.S.M. Number Zone <br /> PROPOSED WORK: BUILDING: FLOOD DISTRICT: AREA: <br /> Subdivision New General FP .r x <br /> Filling Addition Regional FF Square feet <br /> Grading Alteration .) Regional FW RFE USGS <br /> Mineral removal Moving Top of fill USGS <br /> Dredging Z.P.# Z000c7`Z2_ FIRM ZONE Cost <br /> Owner CONTRACTOR/BUILDER <br /> I 11 / s 1 ) 6,L-( <br /> LAS sin i1 <br /> Signed: (Owner/Agent) Date <br /> Permit issued /4-)/7/00 Permit denied Reason <br /> Fee $ / 2c. 00 By: S( Date i©y7/ofr�' <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 /> • <br />