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Fig' A. Location of proposed structures and <br /> existing structures, well, sewage rye• <br /> terns, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> - and back yard dimension and foes <br /> r• tion and setback from all bodies of <br /> water. H property is located at a <br /> highway intersection, show the inter. <br /> secting highways and the setbacks <br /> F 15� a3, required along them and at the in. <br /> 1 F`, tersection, together with vision dear. <br /> ance triangles. <br /> -J <br /> _ PERMIT FEES <br /> Land Use ............. .....E 1.00 <br /> uai u <br /> Building .... ... ....... .... . 5.00— <br /> Sanitary <br /> .00—Sanitary .... .... . .... . ..... 10.00".' <br /> Well .......... .... ..... ..... 5.00 <br /> Septic <br /> 75"s FYd M h q WILI, Combination Building, Sanitary1�` <br /> J <br /> and Well . .... .... ...... .. 15.00 <br /> 0 Conditional .........../'. l0.0 <br /> x. .t•. . . � . .. .... . .3 <br /> Signa ure of Ower or Agent Date iZGning Adstrator <br /> ACTION Site approved (date) ... ......... / ........ .. <br /> Permit Issued (date) . . .... .... ..J�.—.—(C-II� . .. . Receipt No. �r.��.qq// �... . Fee <br /> Septic Tank Permit Issued (date) . ..... ) .... . No. Fee $1.00 <br /> Conditional Permit Issued (date) ... .... . . ....... . .. .... . No . ... ..... ... Fee 5..........:. <br /> Certificate of Compliance Issued (date) W ` S 7J. <br /> Permit Denied (date) .... ... .... .... . . .. . ... . .. for the following reasons . .... . . ......... . .... .... ..... <br /> . <br /> Work Started (date) . .. . . .... .... ....... . ... Work Co eted (date) .. . ...... .... .......... . <br /> INSPECTION Date ..G. !� .7 ...... Inspector . .. 7. !7 .. <br /> Remar .. <br /> . .... . . . .... ... ... .. . <br /> .... .... . .... . :... ... .. .. 1 ... ... ... .... .� ..... .... ........ .......... ... <br /> .... .... .. ... . .. . . .... .... ... .... .... ....... .... ... .... ... ... .. .... .... .... .... .... ...... .... .. ... <br /> RECORD I <br /> Application to Zoning Committee (date) .... . .. . ... . ... .... . Notice published (date) ..... .............. I <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 />_ .. .... ... . . ... .. ...... . ..... .... ...... . . .... ........... .... .... ........ ... ..... ........ ...... ......... <br /> Copy of Decision to DNR (date) ... .... ..... .. ............. .... .. ...... .. .......... . ... .... . ... . ..... . � <br />