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c� <br /> y `♦ Y <br /> \1 - <br /> Fig- <br /> r Location of proposed structures and <br /> "19- <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 /> y� �n 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 /> r tersection, together with vision clear- <br /> ance triangles. <br /> I �^ <br /> f PERMIT FEES <br /> R� <br /> t Land Use ....... .. .... .....$ 1.00 <br /> Building 5.00 <br /> * 7-- Sanitary . . ... .. .. .. . . ...... 10.00 <br /> Well ..... . . .... .. 5.00 <br /> I` . .. ........ . . ... 'i <br /> � Septic Tank 1,00 <br /> Combination Building, Sanitary <br /> and Well ..... .. .. ....... . 15.00pondi <br /> o .. ... <br /> . . . .. . . . . .. .. .. ... . .. . . ...... nal <br /> ti 10.0 <br /> Signature of Owner or Agent Date Zoningdnostr-. . <br /> ACTION Site approved (date) . .. .. . . . . . ... . ... ......... . ......... . .......... ....... <br /> Permit Issued (date) .. .. . . �rl. /.7- . . .. Receipt No. 0.9.77. . Fee $.4.7* <br /> . <br /> Septic Tank Permit Issued (date) . . .... �,. .�ffi,3 .. . No. 3��� Fee $1.00 <br /> Conditional Permit Issued (date) ... .. .. . . .. ... . . . .. .. .. . No. . . . .. . . . . .. . Fee $. . . . ........ <br /> Certificate of Compliance Issued (date) . .. .. ( f_.V17 .. .. .. . . .. .... <br /> . . . . . . .. .. .. .. .... ... <br /> Permit Denied (date) ... . . . . .. .. . . . . . . . . .. . . . .. for the following reasons . ... .. . .. . . .. .. ...... .. ...... . <br /> . ....... .... .. .. .. ... . .. .. .. .. .. . . .. . . . . . . .. . . .... .. . .. .... .. ... . .. .... .. .. . . .. . . . . .. . . .. . . .. . . . . .. .. . <br /> Work Started (date) .` . .. .. .. . . .. . . ... Work Cleted (date) . . . . . . . . . .. ....... ...... <br /> INSPECTION Date .4 ! .%' . �. /„��7Inspector . . �. � <br /> Remark. .. . . . ... .. .. . . . . . <br /> . . . . .. . . . . ... . .. .. .. .. . . . �.7K* .. "� ... . .�. . . . . .. � . .. .. . ... .... ... . ... . .. .. . . ... <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 />