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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 /> r. t. <br /> and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> water. If property is located at a <br /> it tj fc 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 /> , L � <br /> ,�'` �� � �'�^•..1--i � ante 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 <br /> ;'A tr-� Combination Building, Sanitary <br /> �� .�.�...,-.. and Well . .... . . .. .. .. .... 15.00 <br /> Conditional 10.00 <br /> Signature of Owner or Agent Date Zoning Administrator <br /> ACTION Site approved (date) . . . . . . . .. ..�y ../. .... . .... .. .. ...... ............ .. ... .. .. ...... . <br /> Permit Issued (date) . . . . . . . . ..1.�� .......... .... .. .. ...... ............ .. ... .. .. ...... . <br /> . . . • Receipt No. �. . . Fee $1 ^.. . . <br /> Septic Tank Permit Issued (date) . .. .. .. . . .. . . . . .. . . . . .. . No. . .. .. .. .. . .. Fee $1.00 <br /> Conditional Permit Issued (date) . . . . . . No. . . . . . .. . . . . . Fee $. . . .. . . . . . . . <br /> C <br /> Certificate of Compliance Issued (date) . .-Y l:�-7 1.?)•• .• • • •• •• • • • • • . . . . . . . • • . . . . . . .• •• • <br /> Permit Denied (date) . .. . . . . . . .. . . . . . . . . . . . . . . . for the following reasons . .. . . . . . . .. . . . . .. .. . . . . . . .. .. . <br /> . . . . .. .. .. .. . ..... .. . . .. .. .. .... .. .. . . . . .. . . .. .. . . ... . . . . ... . .. .. . . .. .. . . .. .. .. . . . ... .. . . .. .. . . .. . <br /> Work Started (date) . . . .. .. . . .. .. .. .. .. . . . . . Work Completed (date) . . . . . .. .. .. . . ...... ...... <br /> INSPECTION Datey°! J. �,': . . . .f. .�.1.. Inspector .. . .... . <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 />