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LFig. - location of proposed structuresand <br /> existing structures, well, sewage sys. <br /> toms, roads, etc., should be sketched <br /> in Fig. A. Include road setback, side <br /> end back yard dimension and loca- <br /> tion and setback from aB bodies of <br /> water. H property is located at a ' <br /> �s highway intersection, show the inter. <br /> J setting highways and the setbacks <br /> required along them and at the in. <br /> terseetion, together with vision clear- <br /> ance triangles. <br /> j PERMIT FEES <br /> Iand Use ..... ........ .....E 1.00 <br /> 1 �l .00 <br /> ..... .... . 5. . <br /> Sanitary .....(/... .... .... 10.00 <br /> Well ✓.. ........... . 5.00 <br /> Septic Tank . l....... ..... 1.00 <br /> 777 Combination Building, Sanitary <br /> Building . .... . . <br /> and Well ... .. .... 15.00 <br /> � < C <br /> nditional ......... .... .... 1 .00 <br /> a <br /> Signature of Owner or Agent Date Zo Admi strato <br /> ACTION Site approved (date) ... . ./.�... .... .dd.... . 7....................................... .... .. <br /> Permit Issued (date) .. . .-. .0..-7.3... ceipt No. .S v3.6.?f. Fee <br /> Septic Tank Permit Issued (date) .. ... No.-?.k 3 f Fetil-oo_ <br /> Conditional Permit Issued (date) ....... . . .. ... ... z. ... <br /> No. . ........ Fee $......... ... <br /> Certificate of Compliance Issued (date) . .. �,3/�/... . .... ...... .. . . ... ..... .... ... <br /> Permit Denied (date) . .... . ... .. .... .. .. .... .. . for the following reasons .............................. <br /> .. .... .... .... ........ .. .... .... .... ...... ..... ....................... .... .... .... .. .... ........ . ... .. . _. <br /> Work Started (date) ...?... ..... ..... .... . . ... Work Co pleted (date)�.. ... .. .... ........ ..... <br /> INSPECTION Date . .. . ,J. .�. . ... Inspector ,t6Y.K ..[.7f/,,,,.,,�1 L�i<-.,. .��... ... <br /> .. .... .......... . <br /> .. .. ...... .... .Remarks .. . <br /> . . .. �. .... ...- . ..... �...... 1.... .... <br /> �.. a : ::: ... ...... ........ .... ... <br /> .. ... .... .... ..... .... .... ...... .... .... ...... .... ... .... .... . ..... .... ..... ..... .... .... ...... .... ... <br /> RECORD <br /> Application to Zoning Committee (date) ......... . .. ....... . Notice published (dale) . ...... ............ <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 /> .... .... ... ... .. .... .... . ... .. .. ...... .... .. .... ..... .... ... . . ... ..... .... . . ... . I .. . ..... ..... . ... .... <br /> Copy of Decision to DNR (date) . .... . . ... .. .... ..... ... . . ... . ... . ... .. .. . . . ... . . .. . ... .. .. .. . . .. . .... <br />