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3 X Lti d (U <br /> a <br /> F A. h Location of proposed structures and <br /> C 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 /> `z water. If property is located at a <br /> 0 <br /> Q highway intersection, show the inter- <br /> secting highways and the setbacks <br /> V required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> _ ~ `Ark rl�� PERMIT FEES <br /> Land Use ... ............ .. .$ 1.00 <br /> ;�,� Building . . . . .. . .. . .. .. ..... 5.00 <br /> r�! r <br /> / .�-L �1 L l Sanitary . .. . ... .. ... . . . .. .. 10.00 <br /> �c <br /> Well ... .... .. .... .... .... . . 5.00 <br /> lI Septic Tank . .. ...... .. .. .. . 1.00 <br /> Combination Building, Sanitary <br /> and Well . .... ....... ... .. 15.00 <br /> ari We 5 nditional ..... ...... .... 10.00 <br /> Signature of Owner or Agent ��rr_ te­ Zonin =­� rato <br /> ACTION Site approved (date) . .. .o. . . T. . ... .. .. ........... ... ... ... <br /> Permit Issued (date) .. �. :..�`; . . . .. ... Receipt No. .J-Q. .5 ,/ Fee $. : 7.. .. . <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 />