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Fees: <br /> Off-Premise ....................... $100 Computer#: o <br /> On-Premise ...................... $ 50 <br /> Commercial Directional ... $ 25 <br /> BURNETT COUNTY SIGN PERMIT , i v,�1 <br /> Applicant: GAM1' <br /> Address: H rP Zt, (-4w1P <br /> �� Phone #: 76- �s66- 9 r 7 <br /> U'z.(J Ci/L--f <br /> Property Owner: j r 0 Z(- C AM)7�/ l� <br /> Address: it <br /> Sign Type and Location Information <br /> Type: Off Premise ❑ On Premise Directional ❑ <br /> Town j90K 04Kl,40JR Section_ GL or Na)1/4 5Oj 1/4 Property Zoning <br /> Highway Road Name 3 S Highway/Road Side N ❑ S ❑ E L*"'W ❑ <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 r7S --- 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) 1 (ir-P(-Ac,C n 13 Y <br /> -rk►S 516A✓) <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 offic• is charged with administering county ordinances or other authorized <br /> person to have access to the above described p ises at any reasonable time for the purpose of inspection. <br /> r <br /> Signature Applicant: G /f <br /> Property Owner: 146/'1 Z L- c AM P A55o C 14110 n.) <br /> Sil4n 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 /> 1i s, road intersections,road right-of-ways and existing signs. <br /> 4 <br /> 941 /1 It A k hC4 <br />