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ter-z, <br /> S <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, aide <br /> I 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 /> \, required along them and at the in- <br /> tersection, together with vision clear• <br /> � ance triangles. <br /> AQ_ C�}CI S`)ld+� Pon-C14)1� PERMIT FEES <br /> 1 Land Use . .. .... .. ........ .E 100 <br /> /yl Building . .. .. . . .. . .. .. .. . . . <br /> i 05 N i W A Df 0_11 WU \\\��� 1 Sanitary .. . ... . .. ... . . . .. . . 10.00 <br /> Well ... .. .. .. .... .. .. .. ... . 5.00 <br /> Septic Tank . .. .. .. .... .... . 1.00 <br /> Combination Building, Sanitary <br /> I V and Well ..... .. .. . ... .... 15.00 <br /> ndltional10.00 <br /> a re of Ow r r ent I to Admi*Bt;, <br /> rr <br /> ON Site a r ed (date) . .. . . . . . . .. .. . ........... ¢ ... ..... .. ... ... <br /> Permit Issued (date) . . .. . . .. . . .. . .!:. .`/J. . . . Receipt No. Y!.�?. . Fee .. ..... <br /> Septic Tank Permit Issued (date) . . . .. ... . .. . . . . .. . . .. ... 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 /> .. .. .. .... .... .... .... .. .. .... . . .. . . . ... . . . . .. .. ..... .. .... .... .... .. . . .. . ... . . . . .. . . .. . . . . . . . . . . . . .. . <br /> Work Started (date) . . . . . . . .. . . .. .. ... . . . .. . Work Completed (date) . . . .. . . . . . . . . . ... .. . ... <br /> INSPECTION Date . . . . . .. . . .. . . . . . . .. .. ... . .. . Inspector . .. . . . . . . .. . . . . . . .. . . . . .. . . .. . . . . . .. . . .. .. . <br /> Remarks . . . .. . . .. . . .. . . .. . .... ....... . . .. . . .. . . . . . . .. .. .. .... .. . . .. ... . . . . . . . .. .. . . .. . <br /> .. . . .. . . . . . . .. . . .. . . . . .. . . .. . . .. . . . .. . . . . . . . . . . . .. .. . .. . . .. . . .. . . .. . . .. . . .. .. . . . . I. .. . . .. .. . . . . .. .. . .. <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 />