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A. Location of proposed structures and <br /> .. • existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> J2. 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 /> z tersection, together with vision clear- <br /> ance triangles. <br /> l� PERMIT FEES <br /> t <br /> Land Use . .. ...... .. ..... . .$ 1.00 <br /> Building . . . .. .. . .. .... .. .. . 5.00 <br /> weiL I ( Sanitary . .. . . .. .. . .. . .. .. . . 10.00 <br /> Well . .. .. .. . ..... .. ... ... . . 5.00 <br /> Septic Tank . .. . ... .. ... ... . 1.00 <br /> _ Combination Building, Sanitary <br /> and Well . ... . .. .. . .. ... .. 15.00 <br /> Conditional .. ..... ... . .. .. . . 10.00 <br /> . .. .. .. .. . .. .Agent Z <br /> �� ...... .. . . . . .. . ... <br /> Se of Owner or Date A g <br /> Signature ning Administrator <br /> ACTION Site approved (date) . .. . .. . .. .. .. . . . ... ... .... ..•.......... ...... .. ...... .. .... ... .. .. .. .... . <br /> Permit Issued (date) . . .�� . .. �'.. .. . Receipt No. .. . Fee $. .... . . .... . <br /> Septic Tank Permit Issued (date) .. 7. . . . . . .. . No. 37. 7. . . Fee $1.00 <br /> Conditional Permit Issued (date) . .. . ... . . .. .../. . . . . .. . No. . . .. . .. . . . . . Fee $. .. . .. <br /> date ... .. . <br /> Certificate of Compliance Issued ( ) . ... . . .�/.��� 3,. .. .. . . .. .. . . . . . . .. . . .. .. . . . . .. . <br /> Permit Denied (date) .. . .. .. . . .. .. .. . . . . .. . . . . . for the following reasons . .. .. . . .. .. .. . .. . .. .... .. ..... <br /> .. . . .. .. . ... .. .... .. .. . . .. .. .. . . . . .. ... . . . .. .... .. ..... .. ...... ..... ... ... .. . .. . . . . . . .. . . .. . . . . . . .. .. . <br /> Work Started (date) . . . . . . . .. . . . . . . .. .. . . . . . Work Completed (date) . . . . . . . .. .. . ... .. .. . ... . <br /> INSPECTION Date -73.7.7-3o. .. ..... Inspector <br /> Remarks . . . . .: .. . . . . . . <br /> . . . . . . . . . . .. . . . . .. . . . . .. ... . = L. . . . .. . . . . . e . . .. . .. .. . . . . .. .. . . .. .. . . .. . <br /> . . . . . . .. . . . . . . .. . . . . . . .. .. . . . . .. ... . .. . .. . .. .. . . . . ... . . .. . . . . . . . . . . . . .. . . . . . . .. . . .0 .. . .. . . . .. ... ... ... <br /> RECORD <br /> Application to Zoning Committee (date) . . . . . .. .. . . . . .. . . . . . Notice published (date) . .. .. ... . .. . 0. ..... <br /> Application to Board of Adjustment (date) . .. .. . . .. . . .. .. . . . Notice published (date) . . . .. .. .... . .. .. ... <br /> Appealed to Board of Adjustment (date) . . . .. ... .. . . . . . . . . . Notice published (date) .... . .. .0. ......... <br /> Copy of Notice to DNR (date) . ... . .. .. ...... ....... .. . . .. . .. . . . .. . . . . .. . . . . . . . . .. . . . . .. .. . . . . . . .. . . . <br /> Appeal Heard (date) . . . . . .. . . . . . . .. .. .. . ... .. ... Decision . .. . . . . .. . . . . .. 0 . . . .. .. .. . .. 0 .. ... . .. .. ..0 <br /> .. . ... .. . . .. . ..... .. . . .. . . . . . . .. .. . . .. .. .. . .. . .. .. ... . . .. . . . . . . . . .. .. ... . . . . . .. . . 0. .. . . . . .. .. . . .. .. ... <br /> Copy of Decision to DNR (date) . .. . . . . .. . . . .. . . . . ... .. . .. . . . . . . . .. .. .. . . .. . . . . . . .. . . . . .. . . . . . . . . .. . . . <br />