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S <br /> -Flit. A. Location of proposed structures and <br /> xisting structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> ( and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> water. If property is located at a <br /> highway intersection, show the inter- <br /> secting highways and the setbacks <br /> k 0 required along them and at the in- <br /> '3 0 tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> ....... .......... .$ 1.00 <br /> �1 Building ..... . . ....... .. ... 5.00 <br /> v� U Sanitary. ........ .......... . . 10.00 <br /> Well 5.00 <br /> 1 L Septic Tank ....... ........ . 1.00 <br /> Combination Building, Sanitary <br /> and Well ..... .. ......... . 18.00 <br /> . .. ...... ..... nditional6 ... . .00 <br /> c <br /> �.. ,���-� �vL¢�fl,.(G . ..... <br /> zo Adminis or <br /> Signature of Owner or Agent Date g nist�t <br /> ACTION Site approved (date) . .. . ... .... .. . !.. . ipt N . /. e� ... .. J <br /> Permit Issued (date) .. . . ...... .. ...�/.�//�// eipt No. . a�.l�].. Fee $f. -... . <br /> Septic Tank Permit Issued (date) . .....J:!Y/. .7. . ... No.( . CPA .. Fee $1.00 <br /> Conditional Permit Issued (date) ... . No. . . . . . .. . Fee $. . . .. . ... .. . <br /> Certificate of Compliance Issued (date) . ......... .�' 1�.—^7. .. .. . ... ..... . ........ .... .. . <br /> Permit Denied (date) . ...... .. .. ... . . . .. .. .. .. . for the following reasons ... .. .. .. .. . ..... .... .... ..... <br /> .. .. .. .......... .. ...... . . .... .... ... . . ... . ........................ .... ...... .. .. . ... . . . . .. .. . . .. .. .. . <br /> Work Started (date) . . . . . .. .. .. . . ....... . .. . Work Completed (date) . .. . . . . . ... .. .. .... .. .. <br /> INSPECTION Date ��G �!. .3 1.. ....7., ... Inspector <br /> Remtks .1 . .... . . .. ... ......... .. . . .. .... . . . ......... .. .. .. .... ...... . ... .. .... . <br /> .. . . .. .... .. . ..... ... . .... .. . . . . .. .... . . .... .. .. ..... .. . . .. .. .. . . ....... . ...... .. . ..... ... . ........ . .. <br /> .. . . .... ... . .. .. .. .. . . .. .. .... ........ .......... ..... . . .. . .. . . . . . .. .. .. . ... ...... ...... .. .......... ... <br /> RECORD <br /> Application to Zoning Committee (date) . .... . . .. ... . .... ... Notice published (date) ... .. .............. <br /> Application to Board of Adjustment (date) ... .... .. . . . . .. ... Notice published (date) . .. .. .............. <br /> Appealed to Board of Adjustment (date) ... ... .. ... . ... ... . Notice published (date) ... . . .. ....... ..... <br /> Copy of Notice to DNR (date) ..... ......... ...... . . . .. .. . .. . . . ... . .. . . .. .. . .. . ..... . .. .. .. .. . . .. . . . <br /> Appeal Heard (date) .. ... .... .. . ... ...... ....... Decision ...... . .. ...... . ... .. ... . .... .. .. .. ....... <br /> .. ... . ...... .. ........ . . .. .. .. .. . ... .... .. ........ ..... .. .... .. .. .. .. ...... . . .. .. .... .. .. .... .. ....... <br /> Copy of Decision to DNR (date) . .... .. . . . .. ...... ...... . .. .... .. . . .. .. .. . . . . .. .. . . . . . . .. . . . . .. . . .. .. . <br />