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Fig' A- Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> . tems, roads, etc., should be sketched <br /> O Y` F in Fig. A. Include road setback, side <br /> S /Al and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> I ad � water. If property is located at a <br /> ^ highway intersection, show the inter- <br /> / secting highways andthe setbacks <br /> an 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 ....... ..... ... 500 <br /> 10, <br /> Ar� Well 5.00 <br /> Septi <br /> Combination Building, Sanitary <br /> and Well . ... ..... .... . ... 15.00 <br /> Conditional ......... ... . .... 10.00 <br /> i <br /> . .. . .. .. .... ... . . ... . ... . . . ...r-.a�-.z�. �r � .. h . .. <br /> afore o[ caner or Agent Date Zministra[ r <br /> ACTION Site approved (date) . .... . ... .rr..77. .��77! / ZZ / <br /> Permit Issued (date) .. .. .... ..L.O.I?�::C7��?'.7./. Receipt No. J.7. . Fee $,V:_W:... . <br /> Septic Tank Permit Issued (date) . 7-29...:7 .-.... . . No.��.5.��.�-r Fee $L00 <br /> Conditional Permit Issued (date) . .... ... ... ............ . No. ... .... .. .. . Fee $. .. ... ..... . <br /> Certificate of Compliance Issued (date) ... . .. .... .... .. .. .... ...... ... ... . . .... .. . . .. . ...... <br /> Permit Denied (date) . . . .. . . .. . . .. . . .. . . . . .. ... for the following reasons . . . .. . . .. ...... .... .... ....... <br /> .. . ... .... ...... ... ... .. .. . . ... . .... .. . .. .. . ... ... . .... .... .... .... .... .... . .:. . . ... ... I . .. . ... .. . <br /> Work Started (date) .. . . . .. . . . . . . .. . .... . . . . Work Completed (date) .. . ....j <br /> INSPECTION Date .. a� ..../.G. Inspector .�y� !/.:'.:!.:.5?. .. . . ... <br /> Rem .' .!--4T2!�,':L`r.. ..... . . .... .... .. .. .. .... .. .. .... .. ...... .... ... <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) . .. . . ... . .... .. .. .... .. . .. . . ... . .. .. .... ... . .... ... . .. .. .....7�. . .... . . <br /> Appeal Heard (date) Decision . .... ..... . .. . ... .... .... .... .. .... .... ... . <br /> . I <br /> Copy of Decision to DNR (date) . . . .. . . ..... .. . ..... ... . :.. .... .... .. .. . . .. .. .. . . .... .... .. .. . . .... ... <br /> — �I <br />