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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 /> water. If property is located at a <br /> highway intersection, show the 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 /> Land Use $ 1.00 <br /> Building 5.00 <br /> Sanitary 10.00 <br /> S�< Well 5.00 <br /> -- --- ...--- -- Septic Tank <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> Conditional 10.0 <br /> �Ii!'- . <br /> Signature of Owner <br /> i <br /> Agent Date oning Ad ' ' tratorO <br /> ACTION Site approved (date) �,ry <br /> Permit Issued (date) eel t No. 0.... Fee $./5;0 C <br /> Septic Tank Permit Issued (date) / . No. ,/7 h C‘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 /> Work Started (date) . .. . Work Completed (date) <br /> INSPECTION Date 3 V 7 Inspector <br /> Remarks .K... �a ..Cs✓y: :�..vS. we� ... <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 />