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A <br /> Fig. A. e'o <br /> tl Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> fdt- tems, roads, etc., should be sketched <br /> I in Fig. A. Include road setback, side <br /> i <br /> / ' and back yard dimension and loca- <br /> (�-P ti. and setback from all bodies of <br /> ....... L, --� I water. If property is located at a <br /> highway intersection, show the inter- <br /> setting highways and the setbacks <br /> required along them and at the in- <br /> t tersection, together with vision clear- <br /> anceV` (�� triangles. <br /> D PERMIT FEES <br /> 1'(27 >`s.–/K Land Use $ 1.00 <br /> Building 00 <br /> rYn Sanitary <br /> rri✓ Well 5.00 <br /> // Septic Tank 1.00 <br /> Combination Building, Sanitary <br /> a <br /> I" 4–7- and Well 15.00 <br /> / / J/2e._, Co/itional l, PI g-A-76 <br /> ..00 <br /> /1 p. .../.„.":-. ).• <br /> , - • i <br /> . . . .. . .. .. . <br /> Signatu: of/wner or Agent Date Z--S"`i g 'dminist r'lor <br /> ACTION Site approved (date) f / _ <br /> Permit Issued (date) .. .. .. . . ..:,/ `.–.76.. Receipt No. J� . . 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 /> Work Started (date) Work Completed (date) <br /> INSPECTION Date Inspector <br /> Remarks <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 />