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09/25/2008 14:02 608-267-1540 DANE CO PLANNING PAGE 07/07 <br /> ' DANE COUNTY <br /> 1FPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT N0. FP 5-2 T 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 /> .310 L-4,4.f_ '' - - <br /> N\i Navoo T 25 t�tW �fS- <br /> Number Road Town Sec 1/4 1/4 <br /> 1/2.16 " C1 , eb•G bl-A n --?" <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 54 Addition Regional FF )G Square feet <br /> Grading Alteration X Regional FW RFE 7$'-1 .Z. USGS <br /> Mineral removal Moving Top of fill '1BS.Z USGS <br /> Dredging Z.P.# FIRM ZONE Cost <br /> Owner CONTRACTOR/BUILDER <br /> t7 1 <br /> iL AeD 1 ---1—.9 01 lU c.2.e.e <br /> (a-c ( t,., e cr ro i N s T-e,c.-- ' ,2 <br /> — <br /> (,,� On i O 6-1, /1 L. v <br /> s l�Signed: .�--�r j' ,9 . -- <br /> � )' (Owner/Agent) Date 9;4'),-.5,---//he'Permit issued /0/0? CO Permit denied Reason <br /> Fee $ \ �- By: //r/ _ /4,4... . .4L. _ Date _ 10/8//1/3 <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 />