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Fig. A. <br /> 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— ej water. If property is located at a <br /> highway intersection, show the inter- <br /> 00 � 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 /> 4well�� td ,Sb �� Land Use . . . .. .. .. .. .. . . .. .$ 1.00 <br /> Building . . . . . . . . . . . . . . .. .. . 5.00 <br /> Sanitary . . . . . . . . . .. . . . . . . . . 10.00 <br /> Well . .. .. .. . . .. .. .. . .. . .. . . 5.00 <br /> Septic Tank . . . .. .. .. .. . . . . 1.00 <br /> Combination Building, Sani <br /> and Well . .... .. .. . .... .. 15. <br /> Co tional . .. <br /> .. . 00 <br /> . . . .. . . <br /> ' Signa re of Owner or Agent Date ZoOjAhell�!IiisAir <br /> ACTION Site approved (date) . . . . . . . <br /> Permit Issued (date) .. .. . . .. . . . `./.-/�7 . . ... Receipt No. 2.. Fee $.f�:. . .. . <br /> Septic Tank Permit Issued (date) . . . .. !. .:�4. . . . . . . . No. J��. 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 Cmpleted (date) . . . . . . . ...... ........ ... <br /> INSPECTION Date . <br /> . Inspector . -,� �`."?`.7 . :�?. .. . .. <br /> Re ks . . -4' �,� T!� .. . . . . . . . . . .. . . . . .. .... .. ......... . .. .. .. ..... <br /> ij <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 />