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P DANE COUNTY <br /> Zoning Division <br /> PLANNING <br /> DEVELOPMENT Room 116, City-County Building <br /> 210 Martin Luther King Jr. Blvd. <br /> Madison, Wisconsin 53703-3342 <br /> 4266 Flood lain Development A pp lication Fa x: (6 08) 2 67-1540 <br /> Items required to be submitted with application: <br /> o Site Development Plans <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 5 I, ��-� SS j,yt e c�Yv1�S Contractor's Name S e ' <br /> Address .qs1 G O R-e//O(AYl o ad' Address <br /> Phone `s�O g O �j - I v Phone la O g Po 9 - cl j d <br /> Email l Email <br /> Parcel numbers affected: 07 - .201 - g/Y 36 -2 Town: C vc,te Section: 2 0 <br /> 07 / / - 202 - ie ‘ 30 - / 95/ Cc, 4-Avloain RGI <br /> Property Address: <br /> O1 //' ?0a - 5I36 - 6 <br /> FEMA Panel Map: Floodplain District: Flood Elevation: <br /> Scope of work: (Describe development in detail) / N X s , �'a D; 1 Lh PS <br /> I authorize that I am the owner or have p fission act on behalf of the owner of the property. <br /> Submitted By: Q ��Z Date: 3-- /S- I $ <br />