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ed <br /> Fees: <br /> Off-Premise ....................... $100 Computer#: <br /> On-Premise ...................... $ 50 <br /> Commercial Directional ... $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: 1/e opt e o _ S7�re-t A--t <br /> Address: D <br /> Lm;) D., Phone #: `7/'S—- 2 �-d' <br /> Property Owner: (� guedtkif—I <br /> Address: / j` 7 o <br /> Sign Type and Location Information IG�, 3�_ �� Q A6U'CL <br /> Type: Off Premise X On Premise ❑ Directional ❑ <br /> Town D e f' Section_� GL or �C'/4 N U)'/4 Property Zoning <br /> Highway Road Name �� ed in Highway/Road Side N ❑ S� E ❑ 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 feet. - 7c <br /> Distance from nearest existingoff pre,4iise sign(off premise sign applicants only) feet <br /> Number of existing free standing signs (on-pr mise only) — <br /> V, <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my 76 <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: <br /> Property Owner: <br /> Sin Information Required I S/ n — �zQ n �� �a��� <br /> S�hng' S � � 010 <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 w <br /> lines,road intersections road right-of-ways and existing signs. <br /> / <br />