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Sp v <br /> Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> !.D - in Fig. A. Include road setback, side <br /> 7 and back yard dimension and loca- <br /> 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 /> required along them and at the in. <br /> tersection, together with vision clear- <br /> ance triangles. <br /> fO PERMIT FEES <br /> land Use $ 1.00 <br /> Building . .... .. ......... ... 5.00 <br /> Sanitary ... .... .... ...... .. 10.00 <br /> Well ... .... ............... . 5.00 <br /> Septic Tank ................ 1.00 <br /> Combination Building, Sanitary <br /> and Well ..... .... ........ 15.00 <br /> _ onditional ..... .... ....... 10.00 <br /> Signature of Owner or Agent Date Z g A lslre'CY <br /> ACTION Site approved (date) ... . . . .... .... ................................ ................ <br /> Permit Issued (date) . . Ae.A.4 . PO Receipt No.s.�o7. Fee $.1'57V .. <br /> Septic Tank Permit Issued (date) . ....... .J.0..!?x..)...... No. Fee $1.00 <br /> Conditional Permit Issued (date) ... .... . . ..... . .. .. ... o. ... .... ..... Fee $... . ..... ... <br /> Certificate of Compliance Issued (date) .... ..qT.<Z,n��.�. ...... ........ . . .. ..... ..... ... <br /> Permit Denied (date) . .... .. .. ..... . .... .... . .. for the following reasons ....... .... . ..... .... ......... <br /> .... .... ...... .... .... .... .. .. ... . . ... ...... ... ... ... .. .... .... ...... .... ..... ... .... . ..... ... <br /> Work Started <br /> ��(date) .. . .... . ......... . .... Work Completed (date) . .... . .....-.... .... ..... <br /> INSPECTION Date .Cte/zt . .!-� . .—.f Ll Inspector <br /> Remarks '.!Y .. .... .. ... ..... . <br /> . .. . .... . .... . .. .. .... ..... . .. . ..... . .. . . . .. . ..... ... . . ..'. . .. .. .... .... . ... .. ... I ..... ... .......... ... <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 /> . .. .... ...... ........... .... .... . .... . .... .... . ... ..... . .... . ... ..... . . <br /> Appeal Heard (date) . ..... . .. . . .... ...... ....... Decision ... .... .. ........ .... .. .... ........ ...... . <br /> .. . ....... . ... ...... ... ..... .... .... ...... . ... .. .... ... . ... . ......... .... ........ .... .. .........I .... ... <br /> Copy of Decision to DNR (date) . . . .. ....... .... ............ ..... .............. ...... .... .. .... ....... <br />