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/vv-r TZ S)Lr /1V-r4 <br /> Fig' A' Location of proposed structures and <br /> �a't ti `' existing structures, well, sewage sys- <br /> 4,q l)'(p tems, roads, etc., should be sketched <br /> m 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 /> S' 6 rrequired along them and at the in- <br /> �E�, tersection, together with vision clear- <br /> w rel /a" ��� �, ance triangles. <br /> ^� PERMIT FEES <br /> Land Use . .... ..... . .... .� <br /> Building . .. . . . . .. . . . . . .. . . . 5.00 <br /> Sanitary . . . .. .. .. .. . . .. ... . 10.00 <br /> Well . .. . . . . .. .... ... . ...... 5.00 <br /> Septic Tank ... .. ... . . . ... <br /> I~ Combination Building, Sanitary <br /> and Well . .. . ... .. . . . . . . 15.00 <br /> d/m <br /> itional . . 0. <br /> Signature of Owner or Agent Date inistr r <br /> ACTION Site approved (date) . . . . . . . .. . . .... . ..7. . .. ........ .. . <br /> Permit Issued (date) .. . . . . ....�`G�7���-77/.�. . ceipt No;R Q� <br /> Septic Tank Permit Issued (date) . ..7. .: 6 . . . . . No..3. 1 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 /> . .. .. . . .. .. ... <br /> INSPECTION Date .. v l. . . fQ.7 .. . Inspector . ... . . . . . . . .. . . . . .. . .. . . . . . .. . . . . . . . .. .. ... <br /> Remas . . . .. .. . . .. . . .. . . . . . . . . ...... . . . . . . . . . . . . .. .. .... .. . . .. .. .... . . ..... . .. .... ... <br /> .. . . . .. .. .. .. .. .. . . - . . . ` . ..�.�s-�.c�. . . . � . . . . . . .. . . . .. :. ... <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 />