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SIGN PERMIT APPLICATION — Burnett County, WI a U <br /> fi - z <br /> Permit Fees: o , a ►+ <br /> Off-Premise $100 c <br /> p <br /> On-Premise $50 <br /> Directional Off-Premise) $25 <br /> *NOTE:After-the-fact when no permit is obtained prior to construction)is three times the normal fee. <br /> 0 <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: Wt 5 C c.JX-5 iK <br /> r <br /> Applicant's Mailing Address: <br /> City State Zip <br /> Applicant's Telephone Number: -7( e/sr 6 - 20 to 71� <br /> Applicant's Email: CA <br /> Owner Name: <br /> D A)�— vUo 1�sYY <br /> Owner's Mailing Address: -�a5- <br /> City State Zip z <br /> o # <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> /❑Letter [RPhone ❑Email OJ <br /> Legal Description:SL S W uj <br /> ov t <br /> Lot#: CSM Vol. Pg. OR c <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR <L> 1/4 1/4 <br /> C �• I <br /> Section#:�Town#: ( N Range#:�W Town of. 5(A"l t 55 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> 67l -16- -3-fl1 - C)l,�eq lJ <br /> Parcel#(24 digits):_ — <br /> Tax ID#(1-5 digits)• t <br /> � <br /> Property Site Address#:_ _Ly/n n z <br /> Road Name:c City: Ooh,'J Ur yj <br /> TYPE OF PERMIT(S): Check appropriate box/boxes a <br /> ❑ Off Premise ❑ On Premise ❑ Directional (Off Premise) Fee Rec:�j�J.L <br /> Sign Contractor: <br /> _ o <br /> z� <br /> Anticipated Construction Start Date:_LQL <br /> y� D <br /> 7- <br /> Page <br /> Page 1 of 4 o Z <br /> Burnett County,WI Sign Application—Rev 3/2015 a <br /> 3 <br /> t <br /> x <br /> m <br /> A <br /> m <br />