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na <br /> Fig. 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 /> water. If property is located at a <br /> highway intersection, show the inter- <br /> of 13 13 /7o secting highways and the setbacks <br /> l required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> o h h <br /> V� PERMIT FEES <br /> Land Use . .. .. .. . ... . . .. .. .$ 1.00 <br /> rl� Building . . . . . . . .. . .. .. .. . . . 5.00 <br /> • `� Sanitary 10.00 <br /> Well . .. .. .. .. . . . . .. . . . . ... . 5.00 <br /> Septic Tank . .. .. .. .. .. .. . .0 <br /> Combination Building, Sanitary <br /> and Well . .... .. .. . . ... . . . 15.00 <br /> C ditional . . ... .. . .. . . . 40 <br /> ell <br /> Signature of Owner .. Age Date ZoniTnAd;�nist or ! k <br /> ACTION Site approved (date) . . . . . . . . . . . . . . ././.... .. . . . .... . .. . . .. .. .. . ...... .. . . ...... . <br /> Permit Issued (date) . . . . .. . . . . Receipt No. /,5J0,F . . Fee $ <br /> Septic Tank Permit Issued (date) . .. .. —,llL!-��. . . . . NoL/.I�o;7. . 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 /> .. . . .. .. .. .... .... .. . . .. . . .. .. . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . ... .. .. .. .. .. . . . .. . . . . . . . .. .. . . . . . . . . . . . . . <br /> Work Started (date) . .. .. .. . .. . . . . . .. .. . . . . . Work Completed (date) . . . ../.,. .... .. .... . . .. .. . <br /> INSPECTION Date.�.G.; �.�.... ... Inspector � artcr�f• J` s�� . .. .. . <br /> Remks . .... .. . ... . .. . .. . .. .. .. .. .. .. .. .. . . ........... <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 /> . . . . .. . . . . .. . . .. . . .. .. .. . . .. .. . . .. .. .. .. . . . . . . . . . . .. . . . . . . . . . . . .. .. .. .. .. . . . . . . . . . . . . . . .. . . . . .. . ... . . . <br /> Copy of Decision to DNR (date) . . . . . . . . . . . . . . . . . . ... . . . . . . . .. . . . . . .. .. . . . . . . . . . . . . . . . ... . . . . .. . . . . . . . <br />