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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 /> \'"_— ktEaj in Fig. A. Include road setback, side <br /> L___, 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 /> )\' \/\., <br /> 3 4- secting highways and the setbacks <br /> required along them and at the in- <br /> / tersection, together with vision clear- <br /> ancet triangles. <br /> ' 7 PERMIT FEES <br /> r koz.b;� � 'ax }v if/�f---j Land Use $ 1.00 <br /> rS�'f'p Building 5.00 <br /> Sanitary 10.00 <br /> 401 Well 5.00 <br /> Septic Tank 020 <br /> Combination Building, Sanitary <br /> , ____ IP _ ____ <br /> __—, and Well 15.00 <br /> Co. ''tional <br /> /61/14V3e17. d / - 7 _ <br /> Signature of Owner or Agent Date Zo '1,g Administ or 0 <br /> ACTION Site approved (date) l_ / �7 ,2, <br /> (date) CFI—>� �S�'. p /..l. . . Fee $ /��Permit Issued date _ . . Receipt No. q�} <br /> Septic Tank Permit Issued (date) . .. . ': ✓7� No. /. /.4... . 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) ��ff <br /> INSPECTION Date' . //. �7 7b Inspector . . ` C�. e <br /> Rema s . . . <br /> 6 X-- ' (.t cin-ti , — <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 />