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Fig. A. <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> J� in Fig. A. Include road setback, side <br /> and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> t water. If property is located at a <br /> highway intersection, show the inter- <br /> secting highways and the setbacks <br /> c :), required along them and at the in- <br /> ��j" tersection, together with vision clear- <br /> ance triangles. <br /> PERMIT FEES <br /> Land Use . .... .. . . .. . . . . .. .$ 1.00 <br /> 7 Building . . . . . . . . . .. . .. .. . . . 5.00 <br /> Sanitary . . . . . . ... .. . . . . .. . . 10.00 <br /> Well . .. . . .. .. .. . . .. .. . . .. . . 5.00 <br /> Septic Tank 1,�.. <br /> Combination Building, Sam <br /> and Well . ...... ...... .. . 00' <br /> � .` . . . Conditional ..... . .. ... <br /> .. . . .. . . .. . . ..t .� . . 6 ` F . <br /> Signature of Owner r Agent Date L . <br /> Zoning Admmistra r <br /> ACTION Site approved (date) . . . . . . <br /> Permit Issued (date) . . . . . � .: ,�— •ceipt No. Fee $f, <br /> Septic Tank Permit Issued (date) .�Lr'. . . . . No, _3 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 `'r . . . .. . . Inspector ���`t•�:�Z'Y'�r��C:..�'.-:'�� � . . .. . . .. . . . <br /> Remarks <br /> . . . . .. .. .. . .<. . . . . .. . . . . . . . . . . . . . . . . .. . . .. .. .. . .. . . . . . . . . . . <br /> . ... . . . . .. .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. ... .. . .. . . . . . . . <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 />