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Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> olir� 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 /> i,�e I highway intersection, show the inter- <br /> Fi+'t'wr,e PMo peg ea secting highways and the setbacks <br /> rtabra PoseI <br /> `t''�r� required along them and at the in- <br /> ca�e`i h ;vk sepfii o ° �' tersection, together with vision clear- <br /> appro K. a-34 ance triangles. <br /> S7-ar&11e -f'S-ivy PERMIT FEES <br /> Land Use $ 1.00 <br /> Building 5 <br /> Sanitary 4-�q <br /> 4.0 <br /> � Well 5.00 <br /> Septic Tank 1.00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> yAnditional 0.00 <br /> . ...., .. .. .. <br /> Signature of Owner or Agent Date 2dmini ator <br /> ACTION Site approved (date) / p/� <br /> Permit Issued (date) o`4� !.:7�O. Receipt No' /S 3. . Fee $. <br /> Septic Tank Permit Issued (date) No. 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 Inspector <br /> Remarks <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 />