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Fig' � 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, 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 /> T" t required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> Land Use . .. .. .. .... .... . . .$ 1.00 <br /> Building . .. . . . . . . . . . . . .. . . . 5.00 <br /> Sanitary . . . . ... . . ... . . ... . . 10.00 <br /> — — Well . .. . . . . ... . . . .... ..... . 5.00 <br /> JV - Septic Tank . .. .. .. . . .. .. .. P'_00 <br /> Combination Building, Sanitar <br /> and Well . ...... .. . . ... .. 15.00 <br /> Con 'onal <br /> Signature of Owner or Agent Date on A mmistr�t�r� <br /> ACTION Site approved (date) . . . . . . . . . . . . . . . . / <br /> Permit Issued (date) . . .. .. .. . . .. . . - Receipt No. .r Fee $J. .. . . . . . <br /> Septic Tank Permit Issued (date) . . . .. . . -�'.—Z,. . . . 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 /> .. . . .. .... .... . ..... . . .. .. .. .. .. . . . . . . . . . . . . . . . . . . ... .. . . .. .. .. .. .. .. .. .. . . .. .. . . . . . . . . .I . . . . . . .. . . . . . <br /> Work Started (date) . . . . . .. .. . . . . . . . .. . . .P. . Work Completed (date) . . . .. . . .. .. . . .. .. . . . . .. . <br /> INSPECTION Date .�� ..v� .Oi.1 .�?. Inspector .S/.1.A,. .. <br /> Remarks .. . . .. . . . . . .. . . <br /> . .. . . .. . . .. .. ..©. . . � . .. . . . ` . .. . . . ... . . . . ..3 . ... . �... . <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 />