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v <br /> DANE COUNTY <br /> APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD PLAIN OR WETLAND PERMIT NO. FP S2 2 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 /> Cf 26-.1 c AI &--/✓ar ,�.dy rapt/ - %,'iti.1 al- p . ,w , <br /> Number Road Town "Sec 1/4 1/4 <br /> / i/q cvaa, J r ,e13 <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 bf.Z., <br /> Grading Alteration i Regional FW RFE USGS <br /> Mineral removal Moving Top of fill 1r-'.t. USGS <br /> Dredging /� Z.P.# . FIRM ZONE ,'4". Cost <br /> , f2d,} /6:57DX.A¢T/o/✓ DL d9'-nt7L/47vCE `O// /L.jD.D 20 V <br /> Owner CONTRACTOR/BUILDER <br /> in i �A 6Z/�/GT-dg/4 S/ �A"/T/,S• <br /> � S3 Gl1/�, #.4 r" <br /> 1 <br /> °Z°51 X� Pk • L/ ; a)/x//J !"& L1 <br /> ,✓D. 1-(46,,_)// 4 - .a�Yz �� roN, G(/G 53.5g/ <br /> Signed: (Owner/Agent) Date 9/0/ <br /> Permit issued Permit denied Reason <br /> Fee $ Z S�, "`' B ) „� G'r�! 1 <br /> j Y: S Date ! t ), <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(12/78) <br />