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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 /> 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 /> -0 required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> Land Use . .. ........ . ......$ 1.00 <br /> 247f3V Building 5.00 <br /> Sanitary . . . . ..... .. . . .. .. . 10. p <br /> gay Well . .. .. .. . . .. .. .. .. . .... . 5 <br /> Septic Tank . .. ...... .. ....1. <br /> Combination Building, Sanitary <br /> and Well .... . .. .. .... .... 15.00 <br /> 1(v RA uptaitional .. .. 10.00 <br /> Signature oir Owner or Ag Date Z Admini ator� <br /> ACTION Site approved (date) . .. . . . . <br /> Permit Issued (date) . . .. .. . i �/ fC� ceipt No. Fee $/0=. .. . <br /> ... . . . j /fie <br /> Septic Tank Permit Issued (date) . .. . /--: 7107.. . . .. . 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 .�.p�r 1.9.. 76 Inspector . . . . . . . . . . . .. . . . . .. . . .. .. . . .. . .. . . . . .. .. . . . <br /> . .. . . . . .. . . .. .. . . .. . .. . . . . .. .. . . . <br /> Remarks <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 />