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r—,F�S,,-------------- a <br /> Off-Premise...................... S 100 Computer-#: <br /> On-Premise ..................... 5 50Commercial DirectionalDirectional ... 5 25 <br /> BUI ETT COUNT`L' 5SIGN PERNII":C <br /> Applicant: _—�/ _ C/ s/ - - - — <br /> Address: ---`�—1 Z -?j (o.�- ��- /UU <br /> Phone <br /> Property Owner ! tI_ ----- — <br /> Address: _ � i��v _L�� ----- — <br /> c�o iV E? ` zt)o--------_—_------- — <br /> s,ign Type and Locations Itnformation _�1 I _C a <br /> Type: Off Premise [3 On Premise l9 Directional E] 0 —31 �►�OI- CI C-0 <br /> 44 PAP <br /> Town —22(4_ Section-J _ CTL ----- or__5V)-'/4 s� 1/4 Property Zoning C -' <br /> Highway Road Name /4 _ _ Hlighway/Road Side N ❑ S ❑ E ❑ W ❑ <br /> E)istance from Highway/ .oad Right-Of=Wa -- S' _ feet <br /> E)istance between sign location and nearest road intersection feet from centerline of <br /> --------___-- road/highway, <br /> E)i tance from nearest existing, off premise sign (off premise htgn <br /> Number of existi rig Free standirmg signs (on-premise only) Nam- <br /> I declare ithat this application(including any accompanying;schedule) has been examined by me and to the best of my <br /> knowledge and belief it is tnie, correct and complete. I acknowledge that I am responsible f'or the detail and accuracy of all <br /> infoimaiton conia.1ned in this application(including aiiy accompanying s(Jedule)acid I:Nuther declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burdett Wisconsin in detennining 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 tjab,,).v,, r, ibed premises at any reasonable time for the purpose of inspection. <br /> Signature ApplicanProperty Owner:S n InfrJrurxrition % ` ' r j�� <br /> li <br /> Provide sketch illustrating tale size (by dimensions), shape and rneQ;sage of:;ign. � 2 400 l* C/%. <br /> Provide site plan drawing detailing location and positioning on property with referenced d UZi 7t&ro ert <br /> lines, road intersectiuns, road right.-of-ways and t,xisting signs. Z®A(/� (71,0-)' <br /> � y G <br /> N�" <br />