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F18' 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 /> 3 h tersection, together with vision clear- <br /> 84 1 v <br /> .a v ante triangles. <br /> PERMIT FEES <br /> Land Use . .......... .... .. .$ 1.00 <br /> i ao <br /> , Building . .. . . . . . . . .. .. .. .. . 5.00 <br /> Sanitary . .. . ....... .. . . .. . . 10.00 <br /> Well . .. .. .. .. .. .. .. .. .. ... . 5.00 <br /> Septic Tank . .. .... .. .... . mil <br /> Combination Building, Sanitary _ 1 <br /> and Well 15.00'- <br /> . . .... . .. .. .. .4 <br /> Signature of Owner or Agent Date Zo lEdminist for <br /> ACTION Site approved (date) . .. . . . . . . ... --77y..... ...... ....... / ...... <br /> Permit Issued (date) .. . . .. . . . . .�.3. 7/7. receipt No�/-'w �j Fee $J-g'�..... <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 Co leted (date) . . . .. .. .. . . .. .... .. .. .. <br /> INSPECTION Date In/ p . .f.%1�4:. .� .. :. . .. /. ..ector <br /> Remarks . . . .. . .. � ..... . .. .. .. . . .. .. .. .. ..... .. . . ... .. . . .. .. .. .. .. . <br /> . . . . .. . . . . . . . . . . .. .. . . .. ...�1. . .!.::. .. . . ..(:1 .. .... . . . .. . .. . .. .. . . .. .. . . .. .. .. .. . . . ... .. .. . . ... <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 />