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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 /> ig. A. Include road setback, side <br /> � �`, and back yard dimension and loca- <br /> tion�' Q and setback from all bodies of <br /> QV' ter. If property is located at a <br /> I highway intersection, show the Y 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 /> PERMIT FEES <br /> 4 Land Use $ 1.00 <br /> T-1/0. Building 5.00 <br /> Sanitary 10.00 <br /> Well 5.00 <br /> t <br /> o tG.6e'1 Septic Tank 1.00 Z—''— <br /> y <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> Wei/ G? jonditional A. A. 10.00 <br /> a-eY ‘ir ..),(.6 i..,t ,<-t:-A--) /,---31-- 1 a .Aimiceee.z.-/q <br /> Signature of Owner or Agent Date g Ad ato <br /> ACTION Site approved (date) /pry -7 <br /> Permit Issued (date) (v—3JJtt� /. i yteceipt No. 5 .. . Fee $.�� — <br /> Septic Tank Permit Issued (date) . ../v:' 1 No.7S9 Fee $1.00 <br /> Conditional Permit Issued (date) j f No. Fee $ <br /> Certificate of Compliance Issued (date) . . I l -5 j <br /> Permit Denied (date) for the following reasons <br /> Work Started (date) . . . . Work Coleted (date) <br /> INSPECTION Date .-.1i.(T.U. ...�. ). .i 17 y Inspector . . . 0-A411 � <br /> Remarks <br /> 1 <br /> Qt C -k-/— <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 />