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Ftg',A. ki <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> 50 ��� in Fig. A. Include road setback, side <br /> y -r 1 •O S°'� and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> ✓ ) water. If property is located at a <br /> y L highway intersection, show the inter. <br /> . ) HPJti secting highways and the setbacks <br /> V t�o0 required along them and at the in. <br /> tersection, together with vision clear. <br /> f SLI' I ` ance triangles. <br /> � n <br /> 0 <br /> PERMIT FEES <br /> Land Use . .. .. ........ .....$ I.00 <br /> Building . . . .. . . .. . ... . .... . 5.00 <br /> S P (Z d ( Sanitary ... . ... .... ... . .... 10.00 <br /> P• Well ... .... .... ..... ... .. .. 5.00 <br /> Septic Tank . .. .. .. .... .. .. 1�5 <br /> Combination Building, Sanitary <br /> and Well . ...... .. .. ...... 15.00 <br /> Co itional ... . .... 10,100 <br /> Signature of Owner or Agent Date Zoning Admmistra <br /> ACTION Site approved (date) . .. ... . . . . . . . .. . .... . <br /> . . ... . ../.... ... .... ... ...... .. ... .. ... <br /> Permit Issued (date) .. .... .... . ... . -V//-.�7.. Receipt No. .'.�' cc9��.4.I/J/.. Fee 5.��. .... . <br /> Septic Tank Permit Issued (date) ... :W.-. �.�. .... . No. . 9. OF. $1.00 <br /> Conditional Permit Issued (date) .... . .. . . . . .. .. . . .. . . .. . No. . .. . ... . ... . Fee 5.. .... . .. .. . <br /> Certificate of Compliance Issued (date) . .... ... .... .... . ... .... .... .... .... .... ... ..... ..... <br /> Permit Denied (date) . .. ...... .... .... ... . .... . for the following reasons ... ........ .. .. .... .... .... ... <br /> Work Started (date) .. . .. .. . .. . . ... . ... . . .. . Work Comp ted (date) <br /> . .. . . . <br /> INSPECTION Date �.. .. . . .. " <br /> ...�.'.'�. . .�.33.. . . .. ... ... Inspector . .. . . f. / <br /> .. .. .. ... . ... . .Remarks . .. .. ... . .... .... ... . . . ... . ... ... .. .. <br /> m .. .. .. ... .... .... .. ..... ... . ... .... ... <br /> . ... ....L J. . . . . ... . . . . .. . . .... ... . . .. .. .. . ... . . .. . ... . . . . :... ... . ... <br /> .. ... . .... ... . .... ... . .... .... .... .... .. . ..... ... .... .. . . .. . ... .... .... .... . ... ... 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 /> ... . .. ........ .. ...... .... ........ .... .... .. ... ..... .. . .... ... ... .. .. .... .... .. .. ........ ..... .... ..... <br /> Copy of Decision to DNR (date) . . . .. . . .. . . . .. . . .. ... . ... . . .. . ... .... .... .... .. . . .. . . . ... . ... . . .. . . .. . <br />