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Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tema, 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 /> required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> Land Use . .... ...... ...... .E 1.00 <br /> Building . . . .. . ... .. . ...... . 5.00 <br /> Sanitary . .. . . .. .... .. .... .. 10.00 <br /> Well ..... .. .. .... .. .... .. . . 5.00 <br /> Septic Tank ... ...... ...... . 1.00 <br /> Combination Building, Sanitary <br /> and Well . .... .. .... .. .... 5.00 <br /> nditional ... ........ .. . 00 <br /> re of Owner or Agent Date 7 oniag A ato4r ` C <br /> ACTION Site approved (date) .. .a. .. .. .. •... ... . ... ........ ...... .... ... .. .... .. ... . . <br /> Permit Issued (date) ✓ U^,�J/{//j./'�•� �}. . . Receipt No. °�5?.�.. . Fee <br /> Septic Tank Permit Iss ed (d ( � '/ 7 3.. No. �t. - . Fee $1.00 <br /> Conditional Permit Issued (date) . ....t.. . .. ..... . .. . . .. . No. . .. . . .. . . .. . Fee $. . . ... ... ... <br /> Certificate of Compliance Issued (date) Aa.':11n .�. .. . ... .. . ... .. . . . . .. .. . .. . .. .... . <br /> Permit Denied (date) . .. . . .. . . .. . . . . . . . . .. . . .. . for the following reasons . .... ... . .. ...... .... .. . ... ... <br /> . . .. .... ...... .... .. . . .. .... .. .. .. . . . . . . . . . . .. . . .. ... ...... .. .. .... .. .. ...... . . . . .. .... . . .. . . . . .. . . .. . <br /> Work Started (date) . . . . . .. . . . . . . .. .... . . .. . Work Comp eted (date) . . . .. .. . ... ...... .. .... . <br /> INSPECTION Date .. . 0 � Inspector <br /> nsspector . . . . ..�. <br /> Remarks . . . . . ti. .. .i�l/.... .-.. .d..<.. <br /> .. <br /> - ...uL . • <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 />