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S - ate <br /> Fees: <br /> Off'-Premise ....................... $100 Computer#: l,}lJ`�' ✓1 �� <br /> On-Premise ...................... $ 50 <br /> Commercial Directional ... $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: /Z t/\./ Ct-t:l\/ Go c.F Ci ti F <br /> Address: PC B-n 6 40 20 <br /> S, c r, b T S 4-e Z Phone#: <br /> Property Owner: 62 t:C 1\/sPA CE, ZN <br /> Address: fc 6qr-> J36,n6 WALJxjZA 20 <br /> w1 <br /> Sign Type and Location Information <br /> Type: Off Premise ❑ On Premise X Directional ❑ — 3 9— l ACV <br /> Town DA N/6LS Section 1 4- GL or S L 1/4 S E '/4 Property Zoning ' oZ t <br /> Highway Road Name 1A Ai.coZa RcAD Highway/Road Side N� S ❑ E ❑ W ❑ <br /> Distance from Highway/Road Right-Of-Way 5 feet <br /> Distance between sign location and nearest road intersection is feet. <br /> Distance between sign location and centerline of road/highway is 36 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) Af,0Lri.ti< cc,NcwKKE,vrLy Fort onr-pQC,,,,sE <br /> ,t 6^1 i}WAC&v-7 'rT 5T197E <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: z <br /> Property Owner: "���r� �z � �,r�6;;F z_/Z_ 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,road ht-of-ways and existing signs. <br />