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Fig' A. Location of proposed structures and <br /> e K1�g existing structures, well, sewage sys- <br /> IVA' 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 /> �o PERMIT FEES <br /> V Land Use . .... .. . ... .. .. . . .$ 1.00 <br /> 'ISO Building . .. . . . . . . . .. . . . . . . . 5.00 <br /> Sanitary . .. . . .. . . ... . . . .. . . 10.00 <br /> Well 5 <br /> I ax,c Septic Tank ... .. .. . . .. ..... 1.00 <br /> Combination Building, Sanitary <br /> and Well . .... .. .. . .... .. 15.00 <br /> Condi onal 1 <br /> Signature o Owner or Agent Date Zonin Ad istrat <br /> ACTION Site approved (date) . .. . . . . . . . . . ... ../ . .. .. . <br /> Permit Issued (date) ... . . . ... . 1 . l1. ... Receipt No."/ 5. . / Fee . .. .. . . . . . <br /> Septic Tank Permit Issued (date) . .. .�. .- 0—�f�. . . . No. . ../.a �� 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 r'fr .. . . ... . . . . . Inspector !.G <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 />