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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 /> SEE ATTACHMENTS water. If property is located at a <br /> highway intersection, show the inter- <br /> secting highways and the setbacks <br /> conservation SQfiVIG required along them and at the in- <br /> As per soil recommendation tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> Land Use . .. .. ........ .. . $ 1.0 <br /> Building 00 <br /> Sanitary . .. . . ... .... .. .... . 10.00 <br /> Well ... .. .. . . ...... .. .. .. . . 5.00 <br /> Septic Tank . .. .. ...... .. ... 1.00 <br /> Combination Building, Sanitary <br /> and Well . .... .. .. .. .. .... 15.00 <br /> Coditional .. .. <br /> Signature of Owner or Agent Date 1 Zon�Adminis for <br /> ACTION Site approved (date) . .. .... .. .. .. .. ... .. ... . ......... .. ........... . ......... ... . <br /> Permit Issued (date) . . ,/."/*k-7- !.1.. . . . . .. .. . Receipt No. .0.. . Fee $.1f ..... <br /> Septic Tank Permit Issued (date) . . ...... ... .. .. .. .. .. .. . No. . .. . . . . . . .. . 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 /> .. . ....... .. .......... .. .. .. .. .. .. . . . . . . . . . . .. .. .. ... .. .. .. .. .. .. .. .. .. . ... .. .. . . . . .. .. .. . .. . . . .. .. .. . <br /> Work Started (date) . . . . . . . .. . . .. .. .. .. . . .. . Work Completed (date) . . . . . . . .. .. .. .. .... .. .. . <br /> INSPECTION Date .. . . . . . . . .. .. . . . . .. .. ... . .. . Inspector . . . .. . . .. . . .. . . . . .. . . . . . . . . .. . . . .. .. .. .. ... <br /> Remarks . . . . . . . . . . . . . . . .. . .. .. .... ... .. .. . . . . . . . . . . . . . . . . .. .. .. . . .. .. .. ..... ..... ..... <br /> .. . . . . . . . . .. .. .. .. .. . . .. .. .. . . . . .. . . . . .. . . . . .. .. .. ... . . . . . . .. .. .. . . .. . . .. .. . . . . .. .. .... . ... .. .. .. .. .. . <br /> .. . . . . . . . . .. . . . . . . . . . . .. .. .. . . . . .. . . . . .. .. .. .. .. .. .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ...... .... . . .. .. .. ... <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 /> . . . ... .. . . . . .. .. .. .. . . .. .. .. .. . . . ... .. . . .. .. . ... .. ... .. . . . . . . . . .. .... .... ... . . . . . . . . .. ........... ..... <br /> Copy of Decision to DNR (date) . .. . . . . . . . .. . . .. .. ..... . . . . . . . . .. .. .. . . . . . . . . . . . . . . .. . . .. . . .. .. .. . . . . . <br />