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A; <br /> ' A.IN Location of proposed structures and <br /> _.. __ _ existing structures, well, sewage sys- <br /> I c tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back yard dimension and lo.a- <br /> ie d <br /> tion and setback from all bodies of <br /> water. If property is located at a <br /> highway intersection, show the inter- <br /> ' secting highways and the setbacks <br /> 3'3 t.•j v r I required along them and at the in- <br /> ) r •�.j.. ; r o / al z o tersection, together with vision clear- <br /> ance triangles. <br /> �0; -• <br /> -3c`---�j�' PERMIT FEES <br /> R`" Land Use $ 1.00 <br /> d Building 5.00 <br /> Sanitary 10.0 % <br /> Well 5. <br /> I ry i F Septic Tank 1.0 <br /> ID ti 4 Combination Building, Sanitary <br /> and Well 15,00 <br /> ` Q�J Conditional 10.00 <br /> / / moi! ../. Y✓ Alii; . <br /> ./7 <br /> Signature of Owner or Agent Date Zoning Adminisor, <br /> ACTION Site approved (date) <br /> Permit Issued (date) //1 0 .G Receipt No. /1975- <br /> Fee $ ,/ <br /> Septic Tank Permit Issued (date) ,M 4Z, Z-'> NoA./�.7l.. . 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) ii// <br /> INSPECTION Date ---1'(-/L-,. . / ,.��% / Inspector .a7t: /` F. . .Y,', <br /> Remarks . . .C. . . `'‹. . . . . . (..i.,.. .. .. . . . . . ,. .: :4. .,-. ./..n: .. . <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 />