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Fig' A. Location of proposed structures and <br /> existing structures, well, sewage sys, <br /> tems, roads, etc., should be sketched <br /> � T in Fig. A. Include road setback, side <br /> dtt and back yard dimension and loca- <br /> 31 S ti°l'` tion and setback from all bodies of <br /> j0 i y'+ water. H property is located at a <br /> s� highway intersection, show the inter- <br /> secting highways and the setbacks <br /> required along them and at the in. <br /> trey .rI tersection, together with vision clear- <br />' r xtltnJ once triangles. <br /> PERMIT FEES <br /> Land Use ... .. .. .... .. . . ... 1.00 ' <br /> �\ Building 5.00 <br /> 1 Sanitary . 10.00 <br /> Well . .. .... . ... ..... ... .. .. 5.00 <br /> Septic Tank . . . ... .. .. . . ... .�1 I <br /> 9 Combination Building, Sanitary I <br /> and Well ... .... ... . .... 15. <br /> /{ Condyitgal .. .�..... ...Q <br /> \.. .V` .I. ��.. .... .....' .. ... . . ::ln.. ... . .. . . <br /> ` /..s:..C �.�1�(/L.l�/� <br /> Signature of Owner or Agent Date Zoning Admljristrator U <br /> ACTION Site approved (date) . .. . . .. . ... ./.�."( +� -7/ .. .... ...I... .. ....JCT... . <br /> Permit Issued (date) .. .... . ...,l.rrl.✓.1`�/iC�..,Re�ce/ipt No. Fee $.LJ. . <br /> Septic Tank Permit Issued (date) . . . .. . No. 777LLL . .. ._!JFee $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 C leted (date) <br /> INSPECTION Da[e4fl. .} J` I.�T./... Inspector �l�J.!� ��.C,/ �`-.U�.. .. . <br /> Remarks -V .. .. <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 />