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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 />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 Septic Tank 1.00.-- <br />75 Combination Building, Sanitary <br />`L and Well ................. 15.00 <br />Conditional ................. 10.00 <br />,.,f.. �1 mi=l-.. . <br />Signature... <br />of Owner or Agent DateZoning Administrator <br />ACTION Site approved (date)................................................................. <br />Permit Issued (date) .. ( ..... f.--. ....... Receipt No Lf. ��(/ ..... Fee $% ....... . <br />Septic Tank Permit Issued (date) .. A�-7 7. ...... No. 1. 4P_:.. Fee $1.00 <br />Conditional Permit Issued (date) ......... No . ............ Fee $............ <br />Certificate of Compliance Issued (date) .... u/ 9:71.1111-1 . <br />Permit Denied (date) .......................... for the following reasons .............................. <br />...................................................................................................... <br />Work Started (date) ........................ Work Completed (date) ........................ <br />INSPECTION Date .. ID . �O.. l... Ins ector �. <br />Remarks..... .. . .... <br />.....1........ �............... <br />Ir . . . . . . . . . . . . . <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 />