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W .a. y,.w <br />Fig. A. <br />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 />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 ............. b.00- <br />Sanitary <br />0`'Sanitary ..i/. �°� ........ <br />Well ..................... 5.00 <br />Septic Tank ................ 1.00 <br />j Combination Building, Sanitary <br />`� and Well ................. 15.00 <br />Co it�ijon/al .... j 4100 <br />Signature of Owner or I bate Zo g Adminis or <br />ACTION Site approved (date) ............. ........... .................. <br />Permit Issued (date) ............t .:. : /. .. Receipt No. / 5 3.f Fee $............ <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 Started (date) ........................ Work Completed (date) ....................... <br />INSPECTION Date ............................ Inspector ........................................... <br />Remarks.............................................................................. <br />...................................................................................................... <br />...................................................................................................... <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 />