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Fig <br /> ' 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 /> required along them and at the in- <br /> / / tersection, together with vision clear- <br /> ance triangles. <br /> A/(j(/ <br /> PERMIT FEES <br /> / Land Use $ 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 15.00 <br /> •. —� �S C ditional . 00 <br /> /�/e41 <br /> Signature of Owner or Agent Date Zo g Administrat <br /> ACTION Site approved (date) JJ,^ r �J <br /> Permit Issued (date) _C1'7S, Receipt No. /1*70Fee $. J.0-eha2 <br /> Septic Tank Permit Issued (date) No. <br /> 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 In Spector <br /> Remarks <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 />