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Fig. A. <br /> Location of proposed structures and <br /> existing structures, well, sewage sys- <br /> C",`II �A tems, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> and back <br /> v. yard dimension and loca- <br /> S <br /> C tion and setback from all bodies of <br /> �0 C <br /> 'Water. If property is located at a <br /> phighway intersection, show the inter- <br /> ( setting highways and the setbacks <br /> .O� required along them and at the in- <br /> tersection, together with vision clear- <br /> ance triangles. <br /> tl Q PERMIT FEES - <br /> Land Use . .... .... .... .. .. .$,1.00 <br /> Building . ... .. .. ... . .... . . 5.00 . <br /> " Sanitary .. .. 10. <br /> Well . ... . .... .... .... . <br /> MG ! A Septic Tank ... .... .... .. .. <br /> Combination Building, Sanitary <br /> and.Well . ...... .. .. . . ... . 15.00 <br /> C �tionaI ... .... . .... . 10 <br /> low to Date ll <br /> Signature of Owner or Agent Date in Administ or� ��i��� <br /> ACTION Site approved (date) . .. . . . . . . .. .... <br /> y <br /> Permit Issued (date) .. .. .. Recei [ No. See $�s... . ... <br /> Septic Tank Permit Issued (date) ... ./f.:� .:7(p. .. . No. ee $1.00 <br /> Conditional Permit Issued (date) . ... ... . . .. .. . . . . .. . . .. . No. . .. . ... . ... . Fee $. .. ... . .... . <br /> Certificate of Compliance Issued (date) . ... . .. . . .. . .... . . .. ... . .... ... . .. . . . . .. .. . . ... . .... . <br /> Permit Denied (date) .... . .. . . .. . . ... . .. .. .. . . . for the following reasons . . . .. . . .. . ..... .... .... .... ... <br /> .. .. ..... ......... .. . ..... .. .. ... . ... .. . . ... . . .. . . .. . .. .... . ... .... . ... . ... .... . ... . ... . . . . .. .. ... . . . . <br /> Work Started (date) . .. . . . . .. .. .. . ... ... . . . . Work C leted (date) .. . .. . . . ... .... . ... ..... <br /> .... <br /> INSPECTION Date�`�jj..�fij/. .p�. .. . ...?�6 Inspector <br /> .. . .. . . .. . . .. . ... . ... . <br /> . . .. .. ... . ... . . ... ... . .... .. . . ...'. . . . . .. . .. . . . .. . . .. . . . . . . . . . .. . . .. . . ... . ... . ... . .. . . ... . .. . . .. . . .... . <br /> . . .. .... . . .. . ... . . .. . . .. . . .. . . .. . . ... . . . . ... . . .. . . .. . .. .. .. . .. . .. .. I ... . . <br /> RECORD <br /> Application to Zoning Committee (date) . .. . . .. .... . .I. .... . Notice published (date) . .. .... .... .... .... <br /> Application to Board of Adjustment (date) .... . . .. .. . . .. . ... . Notice published (date) . .. .... ............ <br /> Appealed to Board of Adjustment (date) . ... . ... .. . . ... . ... Notice published (date) <br /> ..... .............. <br /> Copy of Notice to DNR (date) ... .. .. ... : .... .... ... .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . ... . . <br /> Appeal Heard (date) . ... . .... . ... . ... . ..: . . ... .. Decision . . ... . . .. . . .. . ... I ... ... . .... .. ... . .. ..... <br /> .. .... .... ... . . ... .... .... .... . ... .... ... <br /> . . . ..'. ... .. .. . .. . . .. . ... . . .. .. .. . ... . . .. ........ . ..... .. ..... <br /> Copy of Decision to DNR (date) . . ... . ... . . .. . .. .. ... . ... ... . . .'.. .... ... . ... . . . . . .. . . . ... .... . . .. . ..... <br />