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Fig <br /> ' A' Location of proposed structures and <br /> l existing structures, well, sewage sys- <br /> kee tems, roads, etc., should be sketched <br /> J_ in Fig. A. Include road setback, side <br /> and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> 1;,..„.., ater. If property is located at a <br /> ffiftghwaY intersection, show the inter- <br /> secting highways and the setbacks <br /> U';" S required along them and at the in- <br /> ,ei oe tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> Land Use $ 1.00 <br /> Building V 5.00 <br /> Sanitary >' 10.00 <br /> Well K 5.00 <br /> �C; cL.< j'•v_,`-) ___ _ Septic Tank 1.00 <br /> Combination Building, Sanitary <br /> S and Well . ...,X 15.00 <br /> i nditij4o.r <br /> l ... /'0 <br /> Ai/at <br /> Signature of-6xeaer or Agent Date i `g (min <br /> ACTION Site approved (date) f �i <br /> Permit Issued (date) .. .. .. ..‘a.-..47:75;... Re eipt No. J..l.5�J!/ . Fee $25-- <br /> Septic <br /> ,/.,- <br /> Septic Tank Permit Issued (date) ....U.-X:725. . ... No. .���`/ ?:-Fee $1.00 <br /> Conditional Permit Issued (date) No. Fee $ <br /> Certificate of Compliance Issued (date) . . <br /> Permit Denied (date) for the following reasons <br /> Work Started (date) . . . . Work Completed (date) <br /> INSPECTION Date `� ,/' Inspector ., ..� <br /> ` ... .. 2./ - - <br /> Remarks ••••. .. t.. . .... -I- Z/C' .e-z �l4' <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 /> Copy of Decision to DNR (date) <br />