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Fig. A. <br />P <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 ................. <br />Sanitary ................ <br />10.00 <br />Well ....................... <br />5.00 <br />Septic Tank <br />.............. 1.00 <br />Combination <br />Building, Sanitary <br />and Well <br />................. 15.00 <br />6 .: � ........... .. ...... C ditional .. ...... ... 1.. <br />Signature of Owner or bate te Z Administ for <br />ACTION Site approved (date) ........... ................ / n ....... <br />Permit Issued (date) .......... L.r! :. 1�-7 <br />eceipt No..7 5 Fee,l L�Septic Tank Permit Issued (date) .... ..... No. <br />�? 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) ........................ <br />Work Completed (date) ... .. ....... . <br />INSPECTION Date f. .... ' .. In Spector <br />Rem si .c.�'? '` .. ..... . <br />................................................. . <br />ftwx*0411 <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 />