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fig' A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> Q 4 tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> Iand 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 /> tersection, together with vision clear- <br /> (/v ance triangles. <br /> Id s PERMIT FEES <br /> A Land Use <br /> . . . .... .. . ... .. ...$ 1.00 <br /> .00 <br /> Building . .. . ... .. . .. . . . .. 5_-�-ti <br /> Sanitary <br /> Well ... . . .. . ... .. .. .. .. . <br /> t Septic Tank . .. .. ... . .. ... I.00 <br /> Lo Combination Building, Sanitary /,� <br /> and Well . ...... .. . ...... <br /> IV Co itional . 0. <br /> C� ) I A <br /> Signature of Owner or Agent Date Zonim Administer <br /> ACTION Site approved (date) . .. . . . . . . ... . .. . ........ ._.. ........ .. . .. .. .. ... . . <br /> Permit Issued (date) .. . . . . .... . . . f�✓�` Receipt No. . <br /> t Fee $.1.. . . . . . . . <br /> �'/� "�7/ ✓�+-7 Fee $1.00 <br /> Septic Tank Permit Issued (date) . . . .. . . . . .. .1& . . . . . No. . . . . 1. <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 ompleted (date) . . . .. .. .. .. .. .. .. . . . .... <br /> - <br /> INSPECTION Date, . y c <br /> �.-��� � � 9.7 4. Inspector . . .. . . .. . <br /> Remarks ���..1..CF:?t•`•: :`�. . . . . . . . . . . . . . .. . . .. .. . . . . .. .. <br /> Jam. <br /> v � z -{a <br /> .��=` . <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 /> Appeal Heard (date) . . . . . .. .. .. . . . . .. .. . . .. . . .. . Decision . . . . . .. . . . . . . .. .. . . .. . . .. .. .. .. ... . .. .. . .. <br /> .. .... . . .. ... ... .. .. .. .... .. .. .. .. . . .. .. . . .. . . .. . . .. . . . .. . . . . . . . . .. .. . . . . .. .. .. . . . . . . .. .. . . .. . . . . .. . .. <br /> Copy of Decision to DNR (date) . . . . . . . . . . .. . . .. ..... ... . . . . . . . .. .. .. . . . . .. .. . . . . . . .. . . . . . . .. . . .. .. . . . <br />