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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 /> secting highways and the setbacks <br /> Q . Arequired along them and at the in- <br /> i ll L' rt37 _ L/ "tersection, together with vision clear- <br /> s� c ante triangles. <br /> �� PERMIT FEES <br /> ') (N 1 Land Use $ 1.00 <br /> Building 5.00 <br /> Sanitary <br /> Well 5.00 <br /> Septic Tank E00 <br /> Combination Building, Sanitary <br /> �G��f, and Well 15.00 <br /> • Conditional ..1(100..00 <br /> Signature of Owner or Agent Date Z Ad ' trat <br /> ?' •/4 <br /> ACTION Site approved (date) //j <br /> Permit Issued (date) �' Receipt No. . .. Fee $/45— <br /> Septic Tank Permit Issued (date) / No. .3 5 (' 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 /> Work Started (date) . . . . Worrkk�Completed (date) <br /> INSPECTION DateQ `/ / 4 7 Inspector / -t <br /> marks 4 ki.. ` .. _ _ t4 <br /> . . �. . ......22l.�'.2..Cr �- <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 />