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. • <br /> 0 _' if '1 :. A. <br /> 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 /> )t�`l/ r. 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 /> c PERMIT FEES <br /> �� i•: 0 Land Use $ 1.00 <br /> 0 f 'U Building 5.00 <br /> Sanitary 10.00 <br /> Well 5.00 <br /> ---� Septic Tank 1.00F% <br /> Combination Building, Sanitary <br /> i <br /> and Well 15.00 ✓ <br /> f Conditional `2200 <br /> 41-•'rON-e'G------- 54/.7 4 <br /> ature of Owner or Agent Da Z dmi tra <br /> ACTION Site approved (date) <br /> Permit Issued (date) '7`Y il7. . Receipt No. 4: 7 Fee $r S <br /> Septic Tank Permit Issued (date) ,( ,-.e 7-- No: .-�. . Fee $1.00 <br /> Conditional Permit Issued (date) No. Fee $ <br /> Certificate of Compliance Issued (date) . ...4,/!7/7 ? <br /> Permit Denied (date) for the following reasons <br /> Work Started (date) . .. . Work GCompleted (date) <br /> INSPECTION Date . ..l. . . .. .C.rr IQ7 Inspector ..`. -e. 1.c-:U..0 ,, . .... .. .. .. <br /> Remarks ,,-P-744. . 0 K.a, �: � ............. .). .47.1J,r.7.:4 ..cPY.,1,N,F41 o <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 />