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Via A. <br /> Location of proposed structures and <br /> j 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 /> . <br /> Sanitary .. ........ .. . <br /> .... 10.00 <br /> Well ......... .. ...... ...... 5.00 <br /> Septic Tank ................ 1.00 <br /> Combination Building, Sanitary <br /> and Well . .... .... .... .. .. 15.00 <br /> onditional ... ... .. . .00 <br /> Signature ' . ... <br /> of Owner or Agent Date o g A rator <br /> ACTION Site approved (date) . . . ... . .. . . .. .. .... .. .......... n <br /> Permit Issued (date) .. .. .. ...y'��,��� Receipt No. 1, -.0. .Fee <br /> Septic Tank Permit Issued (date) . .... .. . ... .. .. .. .. .. .. . No. . .. .. .. .. ... 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 ... . . .. .. .... . . . . .. .. .. .. .. . 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 /> Copy of Decision to DNR (date) . .. . . . . .. . . . .. .... ..... .. ... . . . .. .. .: .. . . .. . . . . . . .. . . . . . . .. .. .. .. .. .. . <br />