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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: "5//Z Eiv �L_6no 6o L F Cz.U l; <br /> Address: PC: P"x 6 4 0 qE C,6 I'JAL_tqoz.a Po <br /> S;R EN W 9-48 --Z Phone#: (7,s 3¢9-0000 <br /> Property Owner: <br /> Address: Po ?x C-4-0 P&o, 6 LVALOOk-A Po <br /> Sr z G, JA✓= S¢-F Z <br /> Sign Type and Location Information //// <br /> Type: Off Premise ❑ On Premise l Directional ❑ fq- 3 1-1 <br /> Town NAltELs Section 14- GL, or IV LV '/4 St 1/4 Property Zoning UA,,,?­y6v <br /> SA�rc- N cf0(,-A <br /> Highway Road Name � Y 7-0 Highway/Road Side N ❑ SX E ❑ W ❑ <br /> Distance from Highway/Road Right-Of-Way 2 feet -sC-- .4Tr'4cHev si«ch- <br /> Distance between sign location and nearest road intersection is -Z/ 90n feet. <br /> Distance between sign location and centerline of road/highway is B4 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) Aert-yl,6- covc,Nr2,RE,TLy F:Prz o1v-P1zc v1s6 <br /> 5i&V AOJACc-vi Ta W4101IR4 )ZIAD. <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: _ ter �i � Z12-610 z <br /> Property Owner: � ���mr� ,�i �r,�:�r -2-1z C,lo z <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,r ad right-of-ways and existing signs. <br /> � �3 <br />