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SIGN PERMIT APPLICATION— Burnett County. WI b <br /> a Z <br /> ►. <br /> Permit Fees: a' a � <br /> Off-Premise $100 <br /> On-Premise $50 <br /> Directional(Off-Premise) $25 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: ?�i()1nt�S C Qt CN. // r r <br /> Applicant's Mailing Address: 6U07 <br /> !/ ity tZip <br /> Applicant's Telephone Number: 7/cf—k-s"/ —3��7 v`J <br /> J r <br /> Applicant's Email:c/1bf�7f <br /> Owner Name: Sam p <br /> Owner's Mailing Address: <br /> City State Zip <br /> 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter ,Phone ❑Email <br /> Legal Description: <br /> •o <br /> Lot#: CSM Vol. Pg. OR c �° <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 d 1 <br /> a <br /> Section#: Town#: N Range#: W Town of. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system propertypage. <br /> i <br /> Parcel#(24 digits): s <br /> Tax ID#(1-5 digits): <br /> r <br /> Property Site Address:_ n z <br /> n <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Off-Premise On-Premise J Directional (Off-Premise) L� <br /> n Fee Rec: <br /> Sign Contractor: <br /> h <br /> 0 <br /> M <br /> Anticipated Construction Start Date: o <br /> Z o <br /> 0 oo <br /> 0 0 <br /> Page 1 of 4 0 Z <br /> Burnett County,WI Sign Application—Rev 3/2016 <br /> x <br /> m <br /> m <br />