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- <br /> e <br /> r n <br /> Fig. A. l _ Datinoof proposed structures and <br /> xisting structures, well, sewage sys- <br /> S tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and 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 /> ..y tersection, together with vision clear- y <br /> 3> ance triangles. <br /> PERMIT FEES <br /> - Unit Use. . . . .. ..... ... .. ...$ 1.00 <br /> - 7b Building . .. .. .. .. . ... . .. .. . 5.00- <br /> .I Sanitary ... . .. ..... .. . . ... . 10.00 <br /> U. Ln 'V` Well 5.00 <br /> �. Q !v.-� •:\ _� f�. I^ Septic Tank . ........ .. ... .. <br /> Gonekination Building, Sanitary <br /> and Well <br /> - 1 Co ifional- .�-. ' 00 <br /> Signature of Owner or Agent Date Administ for <br /> ACTION Site approved (date) . .. . . .. . . . ✓/....... .. .. . ....... .... .. ....... <br /> Permit Issued (date) .i!/—/ .:.. . Receipt N p �?>//,-.7. Fee $.lsl.:.;. .. <br /> Septic.Tank Permit Issued (date) _1..'A . . .. .. . N.35611. 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 /> ... . ........ .. .. ... . .... .. . . .. . . ... . .. . .. . .... . ... ... .... .... .... .. I . .. I . .. . ... . . .. . ... . . . . ... . .. . <br /> : . .. <br /> Work Started (date) ...®. . . . .. . .. . ....... . .. . . . .. . Workk Co pleted (date) . . . .... :. .. <br /> INSPECTION Date O,6Z�je /, .-y11 1,.x;7{: ,, . Inspector - .. .... <br /> Remarks u!.....!C.. . . .�-.Q.0 PQ.�'. . . .. . . .. .. .. ..... ... .... .. <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) . .. . . .. . ... .. .. .... ... . . ... .. ::.. r. .. . . .. . . .. . . .. . . . . .... .... .... ..... ._.. - <br /> Appeal Heard (date) ... .. . . ... . .. . . .. . . ... . ..... Decision . . . .. . . .. . ... . . ...,... .. . . .... .... . ... .... .. <br /> Copy of Decision to DNR (date) ... . ... ... .. .. . ....... .... . .. . ... . . .. . .. . .:.. .. . :.�. . . . .. <br />