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. . J <br /> 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 /> 92\ and back yard dimension and loca- <br /> �� tion and setback from all bodies of <br /> S� water. If property is located at a <br /> s highway intersection, show the inter- <br /> secting highways and the setbacks <br /> x(y required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> St 7� <br /> PERMIT FEES <br /> Land Use $ 1.00 <br /> J r Building 5.00 <br /> J 3 ± r- h 4 " / Sanitary ` ? <br /> Well 5.00 <br /> Septic Tank <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> C. .ditional 1000 <br /> Signature of Owner or Agent Date Zo s g Administ for <br /> ACTION Site approved (date) y$ /i& <br /> Permit Issued (date) 6/-10-/' . . Receipt No. &�/71J . Fee $.,l " <br /> Septic Tank Permit Issued (date) //...l L'-7). .. . No. /.7g . . 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 lCompleted (date) <br /> ,/ / --z_ �� �_Et <br /> INSPECTION Date ` / 1 Inspector r r <br /> • <br /> Remarks /f" <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 />