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Fig <br /> ' A. - Location of proposedstructures and <br /> O o - existing structures, well, sewage sys= <br /> tems, roads, etc., should be sketched <br /> 10 in Fig. A. Include road setback, side <br /> and back yard dimension and Inca. <br /> .IcrY tion and setback from all bodies of <br /> water. H property is located at a <br /> f highway intersection, show the inter- <br /> .$ setting highways and the setbacks <br /> ,�y 1 required along them and at the in- <br /> c; X qj _ / tersection, together with vision clear <br /> ante triangles. <br /> PERMIT FEES <br /> Lena ..... .... ........'a 1.00 <br /> rJ j v BuBuildingng _ 6.00 <br /> Sani <br /> / Well . ...... .. .... .... .... .. 10.00 <br /> Well . . b.00 <br /> Septic Tank ... .... .... .... 1.00 <br /> Combination Building, Sanitary <br /> . and Well ....... .... .... .. 15.00 <br /> ' a / Z�&dmimspftor <br /> ti�(on�a�l/..... . ...... .. 1 00 <br /> .. -. .. ... . ..`.. .. ......... .. .6.. :. CO.G•C . Ac <br /> Sign tore of weer or Agent Date ACTION Site approved (date) . ... .. . . . . ' ^ ................ ... .. 6... .... .. . <br /> Permit Issued (date) .. .. .. .. -/. 6. ... Receipt No.�( . Fee $.� <br /> Septic Tank Permit Issued (date) . .../��.;1�.:7�. . ... . Nov ..�. ' .�. 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 . .� . . ��t./:j.7.'� Inspector . .. .. .a.:,n,.,.I.n.q.oA�.l'.:,...>,.4 .. ... <br /> Remarks . .. .... .. .. . .... . ....... .:.:_. . ..-.).i .... .. .. .. .. .... .. ..:.. ..._ .... <br /> ... . .'. . ... .... .. .: .. . ..C.C!YhS:`-9? . ... 4_��d.....�-r-,..�-4...51..w�.. .(.O-.dy.Tt1M'l.Qldi!'i�Rli..7 <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) . .. .... .6.. ......6. <br /> Copy. of Notice to DNR (date) . .. ............. ....... .. .... .. . ... .. .. . ... . . . . .... .. .. I ... .. .. .. .. . ... . <br /> Appeal Heard (date) . .. . . .. . ... .. .... ..... ... ... Decision ... .... ..�.. .... .. .. .. . . .... .... .... .... ..�. <br /> . . Copy of Decision to DNR (date) .. . .. . .. . ... . ... ......: .... .. . ... .... .... ... . ... . .. . . . ... .. .. . . .. . ..... <br />