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Fig <br /> ' 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 /> and back yard dimension and loca- <br /> nI tion and setback from all bodies of <br /> I 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 /> fr"( PERMIT FEES <br /> Land Use $ 1.00 <br /> Building 5.00 <br /> Sanitary par 5 . 10A41----V <br /> Well 5.00 <br /> Septic Tank 1.00 <br /> Combination Building, Sanitary <br /> and Well 15.00 <br /> C 'ditional 4,1d640 <br /> 7 /7 cz4 <br /> adko <br /> Signature of Owner or Agent Date Z• g Admimstrat <br /> ACTION Site approved (date) <br /> Permit Issued (date) / �`—.,1. Receipt No. r 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 />