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Fig. A. / Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> /� ems, roads, etc., should be sketched <br /> I in Fig. A. Include road setback, side <br /> and back <br /> yard dimension and loca- <br /> /�„�� ��I +a x a y tion and setback from all bodies of <br /> water. If property is located at a <br /> ^ l! highway intersection, show the inter- <br /> n �— �� y secting highways and the setbacks <br /> 6 --required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> and Use . . . . . .. .. . . . . . . . . .$ 1.00 <br /> Building 5.00 <br /> Sanitary . . . . . . . . . . . . . . . . . . . 10.00 <br /> Well . . . . . . . . . .. . . .. . . . . .. . . 5.00_ <br /> Septic Tank . . . . . . . . . . . . . . 1.0 <br /> Combination Building, Sanitary <br /> and Well . .. . . . . . . . . . . . . .. 00 <br /> 100 <br /> di/t/i/p)o/nal/ : <br /> Signature of ODate Admiais f <br /> wner or Agen or <br /> ACTION Site approved (date) . . . ....... /,C� <br /> Permit Issued (date) . . . . . . . . ..(„(/� � � .. ceipt NFee $. �.7.-. .. . <br /> Septic Tank Permit Issued (date) . . . ..... No. 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 Start e) Work i ted (date) <br /> . <br /> INSPECTION Date . . 4? //c�.�IaspeCtor .�`�. <br /> Rema ../, 2... ..... .. .. .. . . . . . . .[...... . . . . . . .. . . . . .... <br /> F.. :.. ....... ... . . . .. .. .. .. .. .. .. ...... . . . . . . . . . . . . . . . <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 />