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SIGN PERMIT APPLICATION—Burnett County* WI a n <br /> Permit Fees: c V <br /> Off-Premise $100 <br /> �i e_ I,,9 GI t t �i C), <br /> On-Premise $50 / e °' <br /> Directional(Off-Premise) $25 " 1 <br /> *NOTE:After-the-fact when no permit is obtained prior to construction)is up to three times thenormal fee. <br /> 0 <br /> a <br /> Applicant Complete All Sections Below This Line \ <br /> 0 <br /> Applicant's Name: <br /> ra v Z <br /> r <br /> Applicant's Mailing Address: ^ t y� <br /> City State Zip f <br /> Applicant's Telephone Number: 1 I S-Zt 15D nAQ—Q 111 -7 <br /> Applicant's Email: 1y 1✓ a l / C� Iy l <br /> t t_ /,, <br /> Owner Name: of'7v/��Wet /yJ1 j"/ C//�rl (� <br /> Owner's Mailing Address: / `7 �D 6e unly /1 <br /> City State Zip K ° <br /> 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. t <br /> ❑Letterphone []Email <br /> Legal Description: <br /> � I <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 d <br /> f 3. <br /> Section#:�Town#:��N Range#:�W Town of: <br /> *Attach additional page i/needed/or lengthy description OR attach a copy <br /> lofthe deed OR attach tax system property page.* w <br /> Parcel#(24 digits): <br /> Tax ID#(1-5 digits): <br /> Property Site Address: <br /> � A <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Off-Premise /P&-On-Premise ❑ Directional (Off-Premise) Fee-R�ecc: <br /> Sign Contractor: <br /> Anticipated Construction Start Date: J U 1 y Zd / o <br /> Z <br /> z <br /> n <br /> -i <br /> a <br /> m <br /> 0 <br /> z <br /> r <br /> fn <br /> n <br /> L" <br /> Page 1 of 4 0 <br /> Burnett County,WI Sign Application—Rev 3/2016 <br />