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(1,8720/2004 09:28 3492166 B C ZONING PAGE 08 <br /> 5 - v <br /> CFees. COInputer#: v q333_0q <br /> ofr-premise ....................... $100 <br /> on-premise ..................... <br /> Commercial Directional ... $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: <br /> Address: 7 <br /> 12, <br /> Phone #: <br /> Property Owner: 1� L L - <br /> Address: l 1���C7 ,t 7 Lf' <br /> Sign Type.and Location Information <br /> Type: Off Premise ❑ On Premise Directional ❑ <br /> Town p Section �3 GL or AU `/a N W 1/< Property Zoning <br /> Highway Road Name S% P 1) g.-!�— -Highway/Road Side N ❑ S ❑ E#1 W ❑ <br /> Distance from Highway/Road Right-Of-Way feet <br /> Distance between sign location and nearest road intersection is &z�?6 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 /> Number of existing free standing signs (on-premise only) �^ <br /> 1 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 maybe 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: <br /> Property Owner: <br /> Sign Information_Required <br /> Provide sketch illustrating the size (by dimensions), shape and message of sign. <br /> Provide site plaza drawing detailing location and positioning on property with referenced distances tp pTopMy <br /> lines,road intersections,road right-of-ways and existing signs. <br /> � ass 7���•�. �� ° ,Q <br />