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OW remise ....................... $100 Computer#: <br /> On-Premise ................... $ 50 <br /> ... <br /> Commercial Directional $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: sit�✓ 6��,✓ �o�� �c i�g <br /> Address: �� g�x 6`f0 8606 /�/,s�jp,ea ', .A0 <br /> SlzE,✓ W L S 2 Phone <br /> Property Owner: ��s D Dis Tiqi c r- 9 <br /> Address: Alol,- iq ST <br /> Sy����R I-t✓1' S¢S�- %fig <br /> Sizn Type and Location Information - -- _ <br /> Type: Off Premise ❑ On Premise ❑ Directional �,oc,,-(7ov of S16-N NgM,B6-t SS--ZC01 <br /> cu R a6ln-y WA ino a4s.r of Nyy61-0-P-oao. <br /> Town <br /> 1�4NiEt_S Section C Z GL S5 .or c 'a �/a Property Zoning uw LLO NCO <br /> Highway Road Name Roa o 7-0 Highway/Road Side N� S ❑ E ❑ W ❑ <br /> Distance from Highway/Road Right-Of-Way X feet <br /> Distance between sign location and nearest road intersection is 3©o feet. <br /> Distance between sign location and centerline of road/highway is 35 feet. <br /> Distance from nearest existing off premise sign(off premise sign applicants only) N�A feet <br /> Number of existing free standing signs (on-premise only) A/A <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: is% � v,% y/ %ace fi F z <br /> Property Owner: <br /> Sign Information Required — i D Z <br /> t5 �rTAcH�— <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 />