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Y <br /> Fees. C <br /> Off-Premise ....................... $100 S 6 4;u) 4--Computer#: �y C <br /> On-Premise ...... .............. $ 50 �f \ <br /> Commercial Directional ... $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: S/26,) t-6,/ (�;v c_F ��L" ff <br /> Address: Ro X 6 40 t�KoVI' 111A_D0P,4 4Ab <br /> 's-1ge ✓ ki T S-'�tS�T Z Phone#: f iz/S � 3¢9--gin <br /> Property Owner: Wi s LDD%— D/snz,c-, <br /> Address: / 7-0/ /Vo/4771 ¢ Si- <br /> Syp�e�o2 <br /> Sign Tvpe and Location Information <br /> Type: Off Premise ❑ On Premise ❑ DirectionalA <br /> bo <br /> Town D,4N S i6t_ Section t GL r o N A/—""'/4 Property Zoning uy2-otife <br /> Highway Road Name Sr4T-45 ROAD 7� Highway/Road Side N ❑ SX E ❑ W ❑ <br /> 120/PS.6U PIRECTION4L 5',CV 1.S in/ 14-y 70 <br /> Distance from Highway/Road Right-Of-Way ,' feet <br /> Distance between sign location and nearest road intersection is 3U0 feet. <br /> Distance between sign location and centerline of road/highway is 3.S feet. <br /> Distance from nearest existing off premise sign(off premise sign applicants only) IV IA feet <br /> Number of existing free standing signs (on-premise only) /'/4 <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: <br /> Property Owner: <br /> Sign Information Required — Sic AT-r4c14E_b_ <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 right-of-ways and existing signs. <br />