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04/29/2009 03:58 3492166 B C ZONING rH�t ed <br /> �"r JA-C.(lo-Cf� �-iNrl�i t1,ill. 1►! r -_ _ <br /> Fig' A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, aide <br /> S� r and back yard dimension and loca- <br /> g e tion and setback from all bodies of <br /> water. If property is located at a <br /> f awe t` highway intersection, show the inter- <br /> n y secting highways and the setbacks <br /> H required along them and at the in. <br /> tersection, together with vision clear. <br /> i <br /> .� once triangles. <br /> T �1• J c � ��� . <br /> PERMIT FEES <br /> Land Use .. ...* 1.00 <br /> i i a 2.o Building . .................. 5.00 <br /> t�J Sanitary ................... 10.00 <br /> . 8.0 <br /> Well ...................... <br /> Septic Tenn ................ . 0 <br /> Combination Building, Sanitary <br /> and Well .................C16 00� <br /> Co ditionai ...... ....... .00 <br /> 7�. <br /> Sigrt�ture of Uwner as Agent��� � Date r <br /> ACTION Site approved (date) ...... ....... <br /> ... ......... <br /> date) ... ......... <br /> Cil:.7�� ... Receipt No. <br /> Permit leaned (date) ........... // <br /> Septic Tank Permit Issued (date) ..... No. J�1 L OO%. Fee $1.00 <br /> Conditional Permit Issued (date) ........ . ................ No. ............ Fee 8............ <br /> Certificate of Compliance Issued (date) .............................. . <br /> Permit Dented (date) .......................... for the following reasons ..... .......... ............... <br /> ...................... ....... . .... .. .... ............. .............................. .... ...... .. ...... . <br /> Work Started (date) .......... .......... .... Work Completed (date) . .... .................... <br /> INSPECTION Date . 7.-7 !. Inspector <br /> .. �- .r. .. .. ............ ....................... <br /> .... .... .. .......... - ! ! ti ......... .. .. ............ ............... <br /> .. .. .. .. .. .1 . . . ... .. . . .... .. ......I. .... ................. .............. . ... .............I............. <br /> RECORD <br /> Application to Zoning Committee (date) ... ......... ........ Notice published (date) <br /> ................... <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 /> ........ ............. . .............. . ..... ..... . .. ... . . .. .. . .. . . . .. ........ .. .. .. ...... I..... ......... <br /> Copy of Decision to DNR (date) ........................... ................. . . . .......... ............. <br />