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DANE COUNTY Zoning Division <br /> �1 PLANNING DEVELOPMENT Room 116, City-County Building <br /> '' 210 Martin Luther King Jr. Blvd. <br /> Madison, Wisconsin 53703-3342 <br /> FI Phone: (608) 266-4266 <br /> oodplain Development Application Fax: (608) 267-1540 <br /> Items required to be submitted with application: F <br /> o Site Development.Plans <br /> rP l�- � r <br /> Plans shall include scaled drawings of existing topography of the area and proposed final grades of <br /> development. All topographical information shall be in NAVD 1988 and be referenced to a known <br /> benchmark. The plan shall show all existing and proposed building footprints and elevations of lowest <br /> floor elevations. The plans shall include dimensions of ditches, culverts, or other structures existing or <br /> proposed. All plans shall be stamped and signed by a professional engineer or architect. <br /> o Engineering Analysis <br /> The analysis shall include calculations or modeling that shows that the development will not obstruct <br /> flow or will not increase the floodwater elevation 0.01 of a foot or more. All calculations shall be <br /> stamped and signed by a professional engineer or architect. <br /> Owners Name 69e- Z)..64t7_549,0 Contractor's Name AL; G2/J 1a 6,6∎56 Lx <br /> Address 09/U/li igf6 , v€ Address 6k,e 6)49-0 44 �7,-/(/ ,740/ 9/9 <br /> Phone / is ! Phone <br /> 'zs 69c6)Il9 17. f-/Pe7e-ie-4 to r zC j3 <br /> Email S©�rJ��GI',� 'lG�li a,iGt Email ,��¢� X511 j�d�,Ait_P" <br /> Parcel numbers affected: O2 /9/2�(� �Z28� Town: �U•fiiv Section: 49-5 <br /> 2 <br /> Property Address: <br /> / 1 4(,,e4 t.5,( 1 ve' <br /> /-fta/6 <br /> FEMA Panel Map: 9 G Floodplain District: A Flood Elevation: '11-1 <br /> Scope of work: (Describe development in detail) l:- <br /> Rt./17/e-iyi/..3,4(f-e --9/49,e7/0,a,,9/lA4arti <br /> Gtr 7 'rf�4/�ice ' v <br /> I authorize that I am the owne ave permission t act on behalf of the owner of the property. � ���� / -/7 <br /> Submitted By: owne [G��� Date: < <br />