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DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP 513 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 /> 78 Dock s i-' A\Uo n zS- St t•IN <br /> Number Road Town Sec 1/4 1/4 <br /> FL (: Eot' e,r�� 13e�.c.\. ?etrk R-3 <br /> Lot Block Subdivis'i'on or C.S.M. Number Zone <br /> PROPOSED WORK: BUILDING: FLOOD DISTRICT: AREA: <br /> Subdivision New General FP 6S- x +U <br /> Filling . ■ Addition Regional FF Square feet 2400 <br /> Grading Alteration i\ Regional FW RFE USGS <br /> Mineral removal Moving Top of fill USGS <br /> Dredging Z.P.# 2.0080'732- FIRM ZONE Cost <br /> Owner lf CONTRACTOR/BUILDER <br /> 12-24 r_ L.ake s i4=e_ Ir <br /> Ev t r 1 WI_ 5"35-3`( <br /> Signed: (Owner/Agent) Date <br /> Permit issued gNi/OP Permit denied Reason <br /> Fee $ ,Z5-=00 By: Ssktkce.h4 j `� Date Cif--Z(,°-()B <br /> Inspection record: <br /> By: Date C of C issued By: <br /> Plans prepared by C OA t k-Amrorc"aer'.v(-- Date <br /> Land Surveyor/Engineer/Architect <br /> Sent to DNR District Main Office By <br /> Other information <br /> 545-44(12/78) <br />