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Fees: <br /> Off-Premise ....................... $100 Computer#: <br /> On-Premise ....................... $ 50 <br /> Commercial Directional ... $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: ±nA i�fo b alm m ut n d:!:� &b o k-' �%ecej <br /> Address: qL4 I D 1tiV141;, t2o� n <br /> Phone #: <br /> Property Owner: � } d- &g-w 1) Fv� 7.lsfi <br /> Address: <br /> CN,rr.art'i I G - a'sa I a <br /> Sian Type and Location Informational <br /> U� <br /> Type: Off Premise ❑ On Premise A Directional ❑ 90 <br /> Town (11 Mr, Section GL or :S6: 1/4 �� 1/4 Property Zoning <br /> Highway Road Name O o y to tj t2A� Highway/Road Side N ❑ S ❑ E ❑ WX <br /> Distance from Highway/Road Right-Of-Way feet <br /> Distance between sign location and nearest road intersection is feet. <br /> Distance between sign location and centerline of road/highway is feet. <br /> Distance from nearest existing off premise sign (off premise sign applicants only) feet <br /> INumber of existing free standing signs (on-premise only) <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> informaiton contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> Signature Applicant: _GA kL <br /> 0 <br /> Property Owner: <br /> Sign Information Required <br /> Provide sketch illustrating the size(by dimensions), shape and message of sign. <br /> Provide site plan drawing detailing location and positioning on property with referenced distances to property <br /> lines, road intersections, road right-of-ways and existing signs. <br />