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/.o T <br /> 3S� <br /> Fig. A. , <br /> Location of proposed structures and <br /> eexisting structures, well, sewage sys- <br /> tems, roads, etc., should be sketched <br /> h in Fig. A. Include road setback, side <br /> N and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> water. If property is located at a <br /> ahighway 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 <br /> Building �p ' l <br /> �� Sanitary . .. ..... . .. . . . . .... 10.00 <br /> Well ... .. .. .. .... .. .. . . .. .. 5.00 <br /> Septic Tank ... .... .... ..... 1.00 <br /> oT 41,VE Combination Building, Sanitary <br /> and Well ... .. .. .. .... .. .. 15.00 <br /> Conditional .... . . 10.00 <br /> . .... .. ..... ... .. ... .. �.fa ..��.�Q .. ...... . . <br /> Signature of Owner or ent Date g Ad raton'/ <br /> ACTION Site approved (date) . .. . .. . . . .... .. / .. ............ ... .. ..... . .... ... <br /> Permit Issued ,(date) .. . . .. .. . . ..�-1.� �. . Receipt No. � 5 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 /> .. .. .. .. ... . .. .. .. .... .. . . .. .. . . .. .. .. .. .. .. .. . . .. .. . .. . . .. . . . . .. ... ... . . . . . . .. . . . ... . . .. .. .. . . .... .. . <br /> Copy of Decision to DNR (date) . . . .. . . . . . . . .. . ... ... .. . . .. . ... . . . . .. .. . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . <br />