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Flit. <br /> p A. <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 /> r� water. If property is located at a <br /> highway <br /> g y 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 /> H � �V d PERMIT FEES <br /> Land Use ................. .$ 1.00 <br /> Building . .. .. .. .. ..... ..... 5.00 , <br /> Sanitary . ... . .... ... .. .... . 10.00 <br /> Well ... ...... .. ....... ... .. 5.00 <br /> G. <br /> 7- Septic Tank . .. ............. 1.00 <br /> ' Combination Building, Sanitary <br /> and Well . .... .. .. .... ...Si �11 .00 <br /> 0 <br /> / Conditional ...... z <br /> 173 <br /> gnature of Oner orAgent D . ....'.... '.'''''.`47 ngAdministrator ACTION Site approved (date) .... .. .. .. .. ........ /- ...... ... ... , <br /> �y ...... ."� �! <br /> Permit Issued (date) . �` ,�.1.� /�i�. Receipt No. . . Fee <br /> Septic Tank Permit Iss d (da d.f.!?�I.. .. . No. W . Fee $1.00 <br /> Conditional Permit Issued (date) ... . ... . . . .. . No. . .. ... . .. ... Fee $. <br /> Certificate of Compliance Issued (date) . .q.1 1 h�. .. .. ., <br /> Permit Denied (date) . .. .. .. . . .. .. .. .. . . . . . . . .. for the following reasons ...... . .. .... ................ . <br /> .. . . .. .. .. .... ........ .. .. .... .. .... . .. ... .. .. . . ....... .... .. .... .. .. .......... .. ......... .. ... .. .. .. . <br /> Work Started (date) . . . .. .. .. .. .. ...... . . .. . Work Competed (date) . . r <br /> . <br /> / _ <br /> INSPECTION Date -1 . � . ... Inspector .a... ,, <br /> Remarks . ..... ..... ...... .. ... <br /> . . . . .. . . .. .. .. .. .. ... . .. . .. . . .. . t. .. ...... ... .... .. . . ... ... .. .. ... <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 />