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i I <br /> Fig. A. ; <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> l ` 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 /> j` 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 /> �e <br /> PERMIT FEES <br /> W �I Land Use . .. .. .. .. .. .. .. ...$ 1.00 <br /> Z Building 5.00 <br /> �� 7 Sanitary 10.00 <br /> Well . .. .. .. . . .. .. .. .. . ... . . 5.00 <br /> Septic Tank . .. .. .. .. .. . . .. 1.00 <br /> Combination Building, Sanitary <br /> and Well . .. .. .. .. . . . . .. . 15.00 <br /> C ditional ... . . . . . . . 0.00 <br /> Signature of Owner.or Agent Date n' Admini for <br /> ACTION Site approved (date) . . . `. . . . . . ' // .. ... .. .. /� <br /> Permit Issued (date) . . .. .. .. . . `l/!.- CGp. ceipt No. (U Fee $I ... . . . <br /> Septic Tank Permit Issued (date) . . . . .(O.-. . . . . . No.I- 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 4� . . .�`�l �2.. Inspector,;,,,. . . . .. .. .. . .. . . .. .. .. ... <br /> .. ��ti- .� . '.� .' .... Svc <br /> dam. .. . ! �-�` �i��,� • , <br /> RECORD <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 />