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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 /> in Fig. A. Include road setback, side <br /> and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> ii. , a hwater. 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 /> n 'e _.-� - PERMIT FEES <br /> Cr Land Use $ 1.00 <br /> Building 5.00 <br /> Sanitary 10 <br /> Well 5.00 <br /> Septic Tank .00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> 9/th C Co ditional .... ..... 10.00D <br /> i��� <br /> Signature of Owner or Agent Date Vann Ad rator <br /> ACTION Site approved (date) <br /> �' 111 .oI <br /> Permit Issued (date) 9/?/ ?. ceipt No. ��.1 Fee $ . . . .. <br /> Septic Tank Permit Issued (date) . . . . No. .( 4 e $1.0 2,Q0 <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 Dates 1, 7 �6 Inspector �l i. A�� f.Cf. " ''L ` - <br /> Remarks . .. .1 4� / � f.��' �-f <br /> - ` (' __.t-,%.� <br /> i <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 />