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C <br /> SIGN PERMIT APPLICATION — Burnett County, WI z <br /> N N <br /> Permit Fees: 0 CI, <br /> N <br /> Off-Premise $100 <br /> i <br /> On-Premise $50 I 00 <br /> ..(--- <br /> Directional(Off-Premise) $25 <br /> *NOTE:After-the-fact(when no permit is obtained prior to constructionto is up three times the normal fee. 00 <br /> CD <br /> Applicant Complete All Sections Below This Line <br /> 0 <br /> Property Owner's Name: `i' Ili Q7d Li /7 0 1 :) <br /> jS <br /> Property Owner's Mailing Address: / 9(0 t.,t hf bail r)),4f t / ;3/ d �-t Cif f State Zip <br /> Contact's Telephone Number: 7/c- 733 — //S` <br /> Contact's Email: [ p. L ylcia (..,t Jc t 2 4,e •C cfr--'7 <br /> ____. ____ .@„, <br /> Legal Description of Property: NO/J/se('X e/7 fcCei)' !_? //� At ,� (6Q.,1 <br /> v / f �/ <br /> Section#: T O Town#: f/( N Range#: /4" W Town of: Lc,'I J n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* c' <br /> 0 <br /> 7 �^� _3,..:, `1/ •- <br /> Parcel#(24 digits): 6 - - /�p -r D'� yp %c- 7/ CS700u I <br /> Tax ID#(1-5 digits): 02 3 <br /> �/��� i / � b <br /> Property Site Address:7re74,t,,,,,,k / \,,z„b<</ - L L i„T S C N <br /> // / C <br /> 6 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes d <br /> ❑ Off-Premise On-Premise ❑ Directional (Off-Premise) g <br /> Sign Contractor: 5-e/ D 9 <br /> ( ,, <br /> t <br /> Anticipated Construction Start Date: / jam/ Z --- <br /> d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY �_ N <br /> THIS PERMIIT IS SUBJECT TO ALL C NDI IONS LISTED�B L W: x \N <br /> 61 --A/Sfe-rPt4/r /5 a 'A7 I� S /9 t/1 I--Pq/ toQ " z <br /> evil` /'K4/'f et1Ml e by sG/ti''`/7- 0Zo N <br /> 9 yP , n <br /> ____, <br /> -,z Fee Rec:�00— <br /> y Ck#: L/5D <br /> v <br /> m_ <br /> z <br /> z <br /> / � v <br /> Date of staff site visit: /07a/ Z-Z-- Initials of site visi staff: / // <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: /�^"� - DATE:77 0 2u-y N © 0 <br /> // a 5 --� <br /> C - m r— TrAl <br /> O N .+ -&-- <br /> n <br /> C r'v �� <br /> Page 1 of 3 m i.� ;` <br /> Burnett County,WI Sign Application—Rev 12/2021 5 <br /> C <br />