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Fig. A. Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> e r PW in Fig. A. Include road setback, side <br /> and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> N water. if property is located at a <br /> 0 highway intersection, show the inter- <br /> `�;�.`� QS 01p% secting highways and the setbacks <br /> required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> �b Land Use . . . .. .. . . .. . . . . . . .$ 1.00 <br /> vicll ' f Building . . . . . . . . . . . . . . . . . . . 5.00 <br /> S a Sanitary . . . . . . . . . . . . . . . . . . . 10.00 <br /> Well . . ... .. . . ....... . . . . . . . 8.00 <br /> Septic Tank <br /> Combination Building, Sanitary <br /> and Well . .. .. .. .. . . . . . . . . d070 <br /> Conditional 00 <br /> � <br /> . . ...�o:. . . . .. .. . �9/.���. .. . . .. . . ..� .. <br /> Signature of Owner or Agent ate Zoning Administra or <br /> ACTION Site approved (date) ..... 7.. <br /> Permit Issued (date) . . . . .. . . . . .�—�i .. Receipt No. 1. 1.1. Fee $. .�. . <br /> Septic Tank Permit Issued (date) . . . ...../..0.��.���. ... 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 Started date)) . . . . . . . . . ....... ..... . . . . . . Work Completed (date) . . . .. .. . . . . .. .. ..... . . .. <br /> INSPECTION Date ��J�//�.� ,. <.!,, �. Inspector <br /> Remarks SS�/R . �..�:Z z orf .... .. .. . . . . . . . . . . ........ .. .. .. ..... ........... .. ... <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 /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. .. . .. ..... ...... .. . . .. . . . . . . . . .. . . . . . ....R. . . . <br /> Copy of Decision to DNR (date) . . . . . . . . . . . . . . . . . . ... . . .. .. .... .... .... .. .. . . . . . . . . . . . . .a. . . . . . . . . . . . . . <br /> a <br />