2000/05/17 - LAND USE - SGN - Off-Premise

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OUTDOOR SIGN INSTALLATION APPLICATION AND PERMIT Wisconsin Department of Transportation Interstate and Federal Aid Primary Highway Systems ,EM417 1296 Applicant Instructions: Submit the following to the District Office identified in the block entitled, "Mail Completed Permit Application To:" A. 3 copies of this application with ail entries completed down to broken line; B. 3 copies of a sign sketch illustrating the size (by dimensions), shape, color scheme and message of the proposed display; C. 3 copies of a site plan drawing, detailing sign positioning with respect to the highway, direction(s) of the sign's facing(s), and whether the display will be on a building or free standing. The location for On property signing shall be referenced (distance shown) to the nearest part of the building in which the activity is conducted or managed. Include on the drawing the locations of property lines and development features, such as customer parking lots; D. 1 copy of documentation from the jurisdictional zoning authority to prove how the property is zoned, include date current zoning was established. If no zoning has been assigned to the property, include a statement from the jurisdictional zoning authority to the effect that the land is unzoned; E. A check or money order (no cash) made payable to: Wisconsin Dept. of Transportation to cover the required permit fee. (See Item #6 on back.) 1.Highway No. 2.County 3 own ❑City ❑Village 4.HighwaySide ❑North ❑East S( , 64—.) d J 4,14�ne- - OF: /h eo)ja A ❑South Fl;�<t 5.Land zoning(proof supplied) Date of zoning 6.Sign Location Sign to be located within the E quarter of the 5 quarter of Section 2 Propos sign meets all local zoning requirements � / / ❑East YES ❑NO Township J North, Range l t0 ®West 7.Distance between proposed sign site and nearest intersecting highway,road or street ! 1 vv 1 I of the centerline of (Feet) (East,West,North,South) (Identify road measured from) 8.Distance from the highway right of way line 9.Sign to face(compass direction) 10.Sign illumination ❑Steady light (Feet) 7i` 5 0 lights 11.Name and address of person or company who will install the sign if approved 12.Installer license number If none,so state. 13. Sign Category 15. Sign Type ❑More than 660 feet from highway right of way ❑Single Face ❑"V' Type May apply to any of the following: ack to Back ❑Over Under ❑On Advertised Property Free Standing ❑Side by Side ❑On Advertised Property and on building 16.Appl' ant Name Telephone ❑On Advertised Property for guidance of internal traffic n (T5) Fi;J'O'ff Advertised Property (Must complete item #7 on back) Street Address ❑Service Club , Z�4,v- Qi ❑Religious Notice City,State,Zip ❑Sign on officially designated school bus stop shelter S/f 4..X 5-1� ,TZ Affidavit from school officials required Mail Completed Perm rcatiqn To DOT District Office: Patricia OIiOCK ❑ Directional as defined by Subsec. Trans. 201.05 Admin. Code District 8 Sign Permit Cclor'llnator (Must complete item#7 on back) 0 If box is checked, advertiser sign below: 1701 N. 4th St' ❑Official sign (City, Village, Town, County, State, official to be applicant) Superior, WI 54880 If box is checked, official sign below: The undersigned applicant requests permission to install and/or maintain signing as described. / a D (14.Advertiser OR icial Signature) ( ermit Applicant) (Date) ————————————————————————————————————————— PERMIT Subject to compliance by the applicant with all requirements of s.84.30 Wis.Stats.,with Ch.Trans.201 Wis.Admin.Code,with other statutes and codes applying, and with all standard and special provisions on the reverse face or attached,permit approval is granted to authorize installation and maintenance of the specific advertising or informative display described at the precise location defined. This permit will expire one year after the Permit Issuance Date if the sign permitted here is not installed by that time, unless the Department has granted a time extension in response to written justifications. Access from the travel lane or any interchange ramp of any Interstate highway or any other controlled access highway for the installation,maintenance or repair of the sign is expressly prohibited. This Permit is Revocable. Completed by Wisconsin Department of Transportation: RR,Num r Sign Ire csq. ) ,heckNu r /vt• ° Fee Received PermitlssuanceDate PennitNumberr -30-00 JOT Reword{{Numb er (C� �l 95' By �� (Approval for Director f Highway Operations)