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1 <br /> 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 /> at tion and setback from all bodies of <br /> water. If property is located at a <br /> highway intersection, show the inter- <br /> 1 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 /> che <br /> 4/ Land Use $ 1.00 <br /> f 00 1 24¢3c <br /> gd1 <br /> Building 5.00 <br /> Sanitary c <br /> Well 5 <br /> 1.00 <br /> Septic Tank <br /> Combination Building, Sanitary <br /> �--- '00- .�' and Well 15.00 <br /> X.fe (441. p-D Cx ditional . . .a.. . . 10.00 <br /> Signature of Owner or Ag Date Z. t . Admini ator <br /> ACTION Site approved (date) . . . . . . . . . .. / f� fj� <br /> Permit Issued (date) ,�f "'�/� f� /Receipt No. . �j$ Fee $/.4i— <br /> Septic Tank Permit Issued (date) . . . . 4^ 6 No.�a.424!A. 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) <br /> INSPECTION Date ., 7 a7r-. . . . 1. 9. .Z 6 Inspector <br /> Remarks (?/t , . . . jl`'e-1'"' <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 />