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Y <br />i <br />�I <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 ................... 5.00 <br />Sanitary ................... 10.00 <br />Well ....................... 5.00 <br />Septic Tank ...............1.00 1 <br />Combination Building, Sanitary ,— <br />.. .......... <br />and Well .... 15. <br />Co ditional ..... .... 10.00 <br />Signature of Owner or Agent Date Zoning "Administr for <br />�l <br />ACTION Site approved (date) ........... .................... <br />Permit Issued (date) ........... w�,1/1.... Receipt No. 4! .. Fee $ . l :..... . <br />Septic Tank Permit Issued (date) ...... 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 ... ti ..: G - <br />Remarks .. xC .. !.. !.. ?... �� 4f : -- .......... ..... . <br />k' . ............. . <br />......................... 4 G . .. s , . � ....... ..... 4 :�' .. . .!4 � . .... . <br />tt 44 <br />� <br />RECORD 666666 <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 />