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Fig' 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 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 /> 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 /> Land Use .. . .. .. .... .. .. .. .$ 1.00 <br /> Building . . . .. .. . .. .. . . .. .. . 5.00 <br /> Sanitary . . . .. . .. . .. .. . . . .. 0.0 <br /> Well ... .. .. . ..... .. .. . ... . . 5.00 <br /> Septic Tank . .. .. .. . ... .. ... 1.00 <br /> Combination Building, Sanitary <br /> and Well ..... ... . .. .. .. .. 15.00 <br /> Conditional .. ... .... .. .. .. .. 1 <br /> GYM!/}t��/l'!N`: ...... .. .. ... . .. .. . . . . . . . . . . . o g . . . . . .. . <br /> Signatbre of Q�w er or Agent Date Zo : Ad trato <br /> ACTION Site approved (date) . . . . . . . .. .. .. . <br /> Permit Issued (date) .. . . .. ... .Y /'7, 3.. .../. Receipt No. ��lo.g. .. . Fee $IA . := ... <br /> Septic Tank Permit Issued (date) . . .... . .&,14.17.3. ... No. .5 (o(o.q� 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 G(.xe. /.775 . . .. . Inspector <br /> Rearks . . .. . . . . . . .... ... .. .. ..... . . . .1... .. . .. .. .. . . . . .. .. . . .. . . .... .. ... <br /> . . . . . . . . . .QL�.. . . . <br /> �y <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 />