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5,.,L�. � <br /> d <br /> (32 - Fig' A. Location of proposed structures and <br /> F - <br /> structures, well, sewage BY$- <br /> mdIshould bess g Anludead setback, Bide <br /> ) 3J <br /> i and back yard dimension and loca- <br /> tion and setback from all bodies of <br /> water. if property is located at a <br /> highway intersection, show the inter- <br /> secting highways and the setbacks <br /> required along them and at the in- <br /> j tersection, together with vision clear- <br /> ance triangles. <br /> lear- <br /> ancetriangles. <br /> �J PERMIT FEES <br /> W.�o, <br /> � — Land Use . .................$ 1.00 <br /> mcw- <.r . :_ ,":V� I Building . ...... ..... ......... <br /> 2 a d _ I I Sanitary .. ................. 10.00 <br /> Well . .. .................... 5.00 <br /> Septic Tank ................ 1.00 <br /> Combination Building, Sanitary <br /> and Well ................. 15.00 <br /> Cppditional ....... ......... 10. <br /> r?t'.+.�... 411)-.(C.............. ....... J..7.A?k... ... . 4 . . . . .. <br /> Signatufe of Owner or Agent Date Adminis or <br /> ACTION Site approved (date) . .. .... .. .. .. / ...... ... .............�..... <br /> Permit Issued (date) ..... .... . -.J.-7b� . .. Receipt NoGn;. Fee $ � ....... <br /> Septic Tank Permit Issued (date) ... .. .. . ..... ..... ..... . No. ... .. .... .. . 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 /> .... .. .......................... .......... ........... .................... .......... ................ ... <br /> Work Started (date) ... .. .. .. .... ....... . .. . Work Completed (date) . .... .................. <br /> INSPECTION Date ........... .. ... ............ Inspector ..... .. .... .... ........ ...... .............. <br /> Remarks ........ ..... .... ... ......... .. .. ........ .. ...... ............................. <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 /> Copyof Notice to DNR (date) ........................ ........ .. ... ..... .. ... ........................ <br /> Appeal Heard (date) ........... ................. Decision ... ...... .... ... .......................... <br /> ........ .....:.................. .......... ................. .................. .. ....................... <br /> Copy of Decision to DNR (date) . ............................... ....... . ... ... . .. ..................... <br /> - 1 <br />