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Fig <br /> ' 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 /> 04.)/V water. If property is located at a <br /> OA4, highway intersection, show the/ inter- <br /> secting highways and the setbacks <br /> / / <br /> / required along them and at the in- <br /> u� `� tersection, together with vision clear- <br /> ance triangles. <br /> -----1601 PERMIT FEES <br /> ��.Ls�' f s`` , ,�'f/a! Land Use $ 1.00 <br /> 1. <br /> Building 5.00 <br /> 1." Sanitary 1.00 <br /> Well 1E0 <br /> Ar O i Septic Tank M.00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> AIA-i nditional � 10.00 <br /> .(Ju -- ..n\c . T �� ,7IV <br /> . <br /> Signature of Owner or Agent onmg Ad • rato <br /> ACTION Site approved (date) �,p <br /> Permit Issued (date) 7—)3 7 Receipt No.a.2 / Fee $./5 <br /> Septic Tank Permit Issued (date) 7�' . 7 No. -.5:7. .. . Fee $100 <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 Comp d (date) <br /> INSPECTION Date .. /17): ?4 Spector <br /> 4-7 46)01-r7‘-‘1"-dif:'1' <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 />