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_ d <br /> Fig. A. Location of proposed structures and <br /> / existing structures, well, sewage sys- <br /> �`^ tems, roads, etc., should be sketched <br /> rn in Fig. A. Include road setback, side <br /> y and back yard dimension and loca- <br /> Z• tion and setback from all bodies of <br /> water. If property is located at a <br /> Cog y?eie f/� 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 /> tG /./ ance triangles. <br /> PERMIT FEES <br /> Land Use $ 1.00 <br /> Building /r.te. <br /> Sanitary . A-AO � <br /> Well 5.00 <br /> Septic Tank 1.00 <br /> 1 11�;E - Combination Building, Sanitary <br /> and Well 15.00 <br /> � � � C ditional 10.00 <br /> . . .. . .. . . . .. .. . . . 2 / .? <br /> 4/Signature of Owner or Agent Date n' g Admini ator <br /> ACTION Site approved (date) <br /> �7 � .Permit Issued (date) > . . Receipt No 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 />