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-2 79 <br /> - r <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 dimenslon and Inca. <br /> 7QS's tion and setback from all bodies of <br /> water. H property is located at a <br /> highway intersection, show the inter. <br /> secting highways and the setbacks <br /> sl' Gnat, required along them and at the in. <br /> tersection, together with vision dean <br /> rAf(HiuSE ance triangles. <br /> ❑ g <br /> t PERMIT FEES <br /> ur/d, 5� Land Use ... ........ .... ...$ LOD <br /> 7$ _ Building ... . . .. .. ... .. .. . <br /> Sanitary .... ... .. .. ... . . . 10.00 <br /> 50 .... .... .... .... .... . <br /> Well 5.00 <br /> IOb` Septic Tank ... .... ........CiLo <br /> •Wdt� Combination Building, Sanitary <br /> - LAKE and Well . .......... .... .. 15.00 <br /> CTiditional ...... 1000 <br /> ��CZZ(!9aarr or Agent Date g Adminia � for - <br /> ACTION Site approved (date) . ... ... .... . ...........I........... ....... <br /> Permit Issued (date) .. .. .. .... /.: . . .. Receipt No. 1. D��. . Fee $.ls—. ... <br /> Septic Tank Permit Issued (date) .. . � . .. .. . No.35.4- S.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 /> r' <br /> . .. . // <br /> INSPECTIONInspector <br /> SPECTION Date <br /> . . . . . . .,,��..�:.,7.Fy!. �Z.. <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 />