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Fig' A. 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 />s <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 />�d ante triangles. <br />l� PERMIT FEES <br />Land Use .................. $ 1.00 <br />17 S �'�8 E-- � � f Building 5.00 <br />A �K Sanitary ................... 10.00 <br />Well....................... 5.00 <br />Septic Tank ................� <br />Combination Building, Sanitary <br />and Well ................ .00 <br />— / �5.• <br />Conditional .. ..... . <br />Signature of Owner or Agent Date Z in Admini ator - <br />ACTION Site approved (date) ......... .............. .. ....................... <br />Permit Issued (date) ............`. —./�/ Receipt No. aR �&.7 .. Fee $ .:.... . <br />Septic Tank Permit Issued (date) .....ltJ � 1. :776;t ..... No.�;54o' . Fee $1.00 <br />P <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 />( <br />INSPECTION Date . .... 7.T. Inspector!..���L�... ........ . <br />RemaslG'.:`...................................................... <br />laxeJ s �� <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 />