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fig' A. Location of proposed structures and <br /> 1 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 /> i <br /> 1 lion and setback from all bodies of <br /> C 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 /> ante rias together with vision clear- <br /> ance triangles. <br /> q PERMIT FEES <br /> Land Use ... .... .. .. ...... .$ 1.00 <br /> Building ... . .. . ..... .. . . ... 5.00 <br /> Sanitary . . .. ... .. .. . . . . . .. <br /> Well . ... k . . .. ...... .. .. .. <br /> Septic Tank ....... ... .... . a <br /> Combination Building, Sanitary <br /> and Well ......: .... .... .. 15.110 <br /> C dilional ... . ..... .... 10.00 <br /> .ignatu. ... . Owner.. ..... ... . .. <br /> .... .. . . ... . . � . / � <br /> Signature of Owner or Agent Date � - � Admiato� i <br /> ACTION Site approved (dale) . .. .... .. ✓✓✓.. . ..... .... .... <br /> Permit Issued (date) .. .... r..3Q'7�.. ... Receipt No._W5�. .. Fee $."(!' - <br /> Septic Tank Permit Issued (date) . .. .K.��. ..— .. . . ... . . No 35&73 .. Fee $1.90 <br /> Conditional Permit Issued (date) .. . .. . . ... .. . . .. .. . . .. . . . No.j,S6 7 . Fee $... .... .... . <br /> Certificate of Compliance Issued (date) ... . . . . . . . .. . . . . . ... . .. .. .. . . .. . . ... . .. ...... ... .... . I <br /> Permit Denied (date) . .... ... . .. . . .. . . . . .. .. ... for the following reasons . ...... .... .... ..... . . .... .... <br /> .. .... .... .... .... .... .... .... .. . . .. .... . . ... .... .. ..... .... .... ........ .. . . .. . . .. .... .... ... .... . ..... <br /> Work Started (date) . .. . . .. .. ... . .. . . ... . . . . Work Completed (date) . ... . .... .... .... .. .. ... <br /> n <br /> INSPECTION Date n .. . �: 8. .� ..� Q;?..�... Inspector . .. /d. .. al.14 -.. .. .. . <br /> Remarks 'Y."in*u �,'l.ayy��,,{JN.. . .Loan.ny!'.�a+�. <br /> �r <br /> RECORD F -ctT r�t.iL� 6111�G'L, .7�J" .• i• . <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) ... . . .. .... .... .... . .... . . .. .... ... . .... . ... . .. .. .. .I .... . .. <br /> Appeal Heard (dale) ... .. .. . ... . ... ........ .... . Decision . .. ... ....... .... .... .... .:.. .. .... .... ... <br /> .... ... .... .... .... ... . .. ...... .. .. .. . . ... . .. . ... . .... .. . ... .... . ... ........ .. .. ...... . <br /> Copy of Decision to DNR (dale) ... . . . . .. ... .. . ... ... . . .. . ... . ... .. .... I . .. . ... ... . .... .... . . .. . . .... : <br /> - i <br />