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r. <br /> Fig. A.- <br /> f'� Location of proposed structures and <br /> d existing structures, well, sewage rya <br /> ' � tems, roads, etc., should be sketched <br /> fog in Fig. A. Include road setback, aide <br /> ,-tjGf ag `�c mr and back yard dimension and lova. <br /> tion and setback from all bodies of <br /> water. If property is located at a <br /> highway intersection, show the inter. <br /> '�Y/lea secting highways and the setbacks <br /> Ce h JG I required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES - I <br /> Land use . .... .......... ...$ 1.00 <br /> Building 5.00 <br /> 0 �^. Sanitary . . ... .... .... .. ... . 10.00 f <br /> Well ......... ...... .... ... . 5.00 <br /> Septic Tank ..... ......:. .. 1.00 <br /> _\ Combination Building, Sanitary <br /> r�ic and Well . .... .... .......Q5.00, <br /> / Co tional ..... .... 1 00 <br /> ......... . . ... . .. ... <br /> Sigrurs of Owner or antDate Z Adminiet r <br /> ACTION Site approved (date) . . ... . ... . ........... ........... ..... ....... ........ ..... <br /> Permit Issued (date) ... . .. .. .- .77J�.... .. Receipt No.IR-/,/.2,. Fee <br /> Septic Tank Permit Issued (date) . k:7/ 7A... .... ... Fee $1.00 <br /> Conditional Permit Issued (date) ... .... . . .... ..... .. ... . . No. . . . ... . .. .. . Fee 2. ..... ... .. .. <br /> Certificate of Compliance Issued (date) . ... .. .. ... . .. . ... . ... . ... .. .. .... .. ... .. . . ... ....... <br /> _ I <br /> Permit Denied (date) . ... .... .. . .. . . .. .... .. .. . for the following reasons ..... . ... .. .. ......... ..... ... <br /> . .Work Star/te"d' (date) . .. . . .. .... ........ . . . . . Work Completed (date) ....... . ... .../........ .. <br /> INSPECTION Date l.a�t. . . . . . /..r�>. . Inspector e,�..,... ... <br /> Remarks .G..E.. '.!'Z.r -R,.. .. . ... .... .... .... .... ........ .... .... ..... .. <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) ..4........ <br /> Copy of Notice to DNR (date) .... . .. ...4 .... ...4 ... .. . . .. . .. .. .... .. . . . .. . .. . . ... . .... . ... . . . ... . <br /> Appeal Heard (date) . . ... . .. . ... . .. ........ :... . Decision .. . .. . .... . .. . ... . ..... ...... .. ........ ... <br /> . ... .. ... . .... .... ...... .... .. .... ... ..... ... ... ......... ... ... . .... .. ...... .. .. .. .. .... ...... ...... ... <br /> Copy of Decision to DNR (date) ... ............... ....... ... .... ..... ... ..... ... . .. .. .... .. .... .. ..... <br />