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SIGN PERMIT APPLICATION-Burnett County, WI a z <br /> s <br /> Permit Fees: <br /> Off-Premise $100 ° <br /> a- �y <br /> On-Premise <br /> Directional Off-Premise $25 <br /> *NOTE:After-the-fact when no permit is obtained prior to construction is three times the normal fee. 3 <br /> I 3 <br /> Applicant Complete All Sections Below This Line q <br /> e e— <br /> Applicant's <br /> 1 <br /> Applicant's Name: 1 lot S' o "l/"P y s?'e <br /> Applicant's Mailing Address: ��.. QoX o2 lillelst:- <br /> F66 l� City State zip a <br /> Applicant's Telephone Number: 7/57- F66 <br /> Applicant's Email: W//G>SOS / Vyi 1 f a�,rle �9 y�g /. Loowl S <br /> Owner Name: Ui 114 C e 0 —/ <br /> Owner's Mailing Address: /-,1!9- 901C <br /> City State zip z <br /> o <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter %Phone ❑Email <br /> Legal Description: y3 3 (;k 0 A SO 0 <br /> ro 1 <br /> Lot#: CSM Vol. Pg. OR <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 0 <br /> / 3. <br /> Section#:s 3a Town#: 1Z ON N Range#:l� Town of:_ Oe?k l4 N w <br /> t <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> f <br /> Parcel#(24 digits): 07- oda- a- q0- /6 - 3a- y 0!-000-0 tt t'000 <br /> / (J <br /> Tax ID#(1-5 digits): / 3 Yl 2 (� <br /> Property Site Address#:p 383 <br /> 9 v <br /> Road Name: S-1 /(w l 3 S City: <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Off Premise On Premise ❑ Directional (Off Premise) Fee Rec:� <br /> � /' J/ / x <br /> Sign Contractor: i/��J/q S'-C O <br /> m <br /> N <br /> z <br /> z <br /> Anticipated Construction Start Date: n <br /> N <br /> y <br /> a <br /> 0 <br /> z <br /> r <br /> K <br /> f] <br /> m <br /> Page 1 of 4 0 <br /> Burnett County,WI Sign Application — Rev 1/2016 <br /> m <br /> p <br /> m <br />