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b to <br /> a ' SIGN PERMIT APPLICATION -Burnett County, WI a U G� <br /> Permit Fees: ON COMPUTER/SCA1'JNE ? a "' <br /> Off-Premise $100 <br /> On-Premise $50 dp) <br /> Directional(Off-Premise) $25 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is three times the normal fee. <br /> Applicant Complete All Sections Below This Line $W�) <br /> ( <br /> Applicant's Name: CAJt 5CC1'-5 i - Di ) --` .T.- <br /> Applicant's Mailing Address: P O 5 I W,V W t Ya G3 l 0 <br /> City State Zip <br /> Applicant's Telephone Number: '7 f j 6 6 - -2d <br /> 7 <br /> Applicant's Email: '2 b.._.'S Lit 5 vyt 5vr-%--,>C$C1 tA <br /> Owner Name: L. I'. 5u'c - 51,' 0lU r_-.- Goo. .[ham,..„L„S 5614, Q <br /> Owner's Mailing Address: 5 as- 5-1-1. e")0 G ca 610° n <br /> City State Zip E b <br /> , <br /> 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. G <br /> /❑Letter aPhone ❑Email 6 <br /> Legal Description:--S$ ., S W V <br /> ( t <br /> Lot#: CSM Vol. Pg. OR c <br /> Lot#: Block#: Subdivision Name: OR w <br /> Gov't Lot#: OR S 1/4 S W 1/4 d <br /> �. 1 <br /> Section#: (9,0 Town#: ci( N Range#: l 6 W Town of: J c 55 <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> CI)-033„-- -LH -IC-)(3_'/- 6-1-- ::. - 0 1 i ,,,,, i 4) <br /> Parcel#(24 digits): It ` ti <br /> Tax ID#(1-5 digits)• a r 1c3 `f`1 Z. i <br /> n r w ..-C <br /> Property Site Address#:_ • I f/A 0 z f <br /> IF <br /> Road Name:, City: 06,k,_ ^ vr7 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes a <br /> 6 <br /> ❑ Off-Premise 0 On-Premise ❑ Directional (Off-Premise) Fee Rec:\I iv <br /> c\ <br /> Sign Contractor: \J Iv \-. o <br /> r <br /> o Cl <br /> Anticipated Construction Start Date: -(-I — A.O t _) 2 C <br /> > z 73 tiVil <br /> ' MI <br /> O cg <br /> Page l of 4 0 <br /> Burnett County, WI Sign Application—Rev 3/2015 a C:::::: <br /> m <br /> po <br /> m <br />