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3q. <br /> 3.� Fig. A Location of proposed structures and <br /> 7S <br /> existing structures, well, sewage sys. <br /> �` S 4 n tams, roads, etc., should be sketched <br /> 4- <br /> In Fig, A. Include road setback, side <br /> and back yard dimension and lata. <br /> tion and setback from all bodies of <br /> L water. H property is located at a <br /> sy s w't l� highway Intersection, show the inter• <br /> y'(; l� �• setting highways and the setbacks <br /> S'd Ha required along them and at the in. <br /> 00 /� tersectlon, together.with vision dein <br /> cp d` ince triangles. <br /> PERMIT FEES <br /> ✓1.: � <br /> Land ..i 1.00 ✓ <br /> /d dee Building <br /> ng . .. ... . .... ... .... . 8.00 <br /> s. <br /> Sanitary ...... .... .... .... 10.00 <br /> Well ........... ........ .... 0.00 <br /> Septic Tank ... .. ........... .O <br /> Combination Building, Sanitary / <br /> and Well ............... ..C16.00�' <br /> Co ditioml <br /> C.ve� .... <br /> ... ... ........ <br /> .. . <br /> Signature of Owner or Agent Date Administer <br /> ACTION Site approved (date) . .. .... .. . .././... . ..../...... ..4 .............. . ......... .... .... <br /> Permit Issued (date) .. .. .. ... ..UlC. /:774?.. ./Receipt No. �C.7/ . Fee $.��'—.... <br /> Septic Tank Permit Issued (date) .....6-l-710... ... No. 1. Z93.. 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 om <br /> Completed (date) . .. . . .. .. .......... .... <br /> INSPECTION Dete l-� Y. . "t 7 . .�.l In /.��G?�lrtff!/ /�f-F.Y E. t.? ..... <br /> ... ... ... ... ...Re mar aCr% ..�'A?d�«-..r. .... .. .... .... .......... .... .:.. .......... ..... <br /> '11a .zJ 2%t rtfr, �.. .. .. .... .... .. .. .. ...:. ... .. .. .. . . ..... <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 . .... .... ... . .. . ... .... ...4 .... ........... i <br /> .. .Copy of Decision to DNR (date) ... .. .... ....... .......... ... .... .... ... ... . ... .... ... . .. . ... .. .. . . .. . <br />