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• <br /> Fig. A. / <br /> 7c�P� k>0131 / 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 /> c i5 and back yard dimension and loca- <br /> le 4 <br /> 130'- tion and setback from all bodies of <br /> 7>v <br /> 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 /> lE.. 7 , Av PERMIT FEES <br /> Land Use $ 1.00 <br /> Building 5.00 <br /> Sanitary 10.00 <br /> Well 5.00 <br /> Septic Tank 1.00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> �_ Conditional nn 10.00 <br /> Signature of Owner or Agent Date Zoning Administ tor "/ <br /> ACTION Site approved (date) /' �/ <br /> Permit Issued (date) / O / /�— Re eipt No. �. f�? . . Fee $ <br /> Septic Tank Permit Issued (date) . . .. 76 No. 5-2� Fee $1.00 <br /> Conditional Permit Issued (date) h �. . No. Fee $ <br /> Certificate of Compliance Issued (date) . .. .i.P`:n -J <br /> 7 <br /> Permit Denied (date) for the following reasons <br /> Work Started (date) . .. . Work Completed (date) <br /> INSPECTION Date If' inspector <br /> Remarks L ,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 />