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• <br /> ( <br /> SIGN PERMIT APPLICATION — Burnett County, WI a z.z <br /> Permit Fees: _ / O o G a. 41. <br /> Off-Premise 1 o 0� r <br /> On-Premise $50 — i7 (A <br /> Directional(Off-Premise) $25 - vc� <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> V\ <br /> Applicant Complete All Sections Below This Line <br /> r1� o t_. 'i <br /> Property Owner's Name: 1 oaYd rQ( t4- I W I�G LLL- <br /> •Property Owner's Mailing Address: ' 11-J O( Fr al <br /> (An t.rI- 1 If I0 Mar6 C.lcI In)I c 24 o o ik <br /> CoC I r!- '. .. 'ii Flicii � , f 0 �0(i' �/�' ,' �lty�,,^r, State Zip Z' <br /> ntact's Telephone Number: 11 5 �j' 7 ` 5- C��� 'i' V r 5l gt5g4/411 E <br /> Contact's Email: k i6 • � i�C- - L F4/ <br /> t <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is jr --N <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWI.gov .3 ci Q <br /> �? / Z 7 g 6/2-/7 ii, ate O c't� G4/C� n P . <br /> Legal Description of Property: / i ,ll t <br /> Section#: 90 Town#: 1 V N Range#: I LP W Town of: oaAeAct,wA o <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> rs <br /> Tax ID#(l-5 digits): i -94 n <br /> Property Site Address: I p'1-C4"i &'1''1C 1'1 Or-_. CI't-4 /fll t i ' i `-- <br /> 5' <br /> oo <br /> TYPE OF PERMIT(S): Check appropriate box/boxes 0 <br /> 7 <br /> S. <br /> XOff-Premise 0 O'nn-PrreJmiise. ^0 Directional(Off Premise) N <br /> Sign Contractor: �-�.AY Y ri►' I`C/1L-���"v Y ' V <br /> --3 <br /> Anticipated Construction Start Date: ty — o <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY ;v 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: cz <br /> z <br /> .---- .) .! <br /> z Fee Rec:3 C 7 O° <br /> y Ck#: II(?j <br /> 0 <br /> m <br /> E <br /> 0 <br /> m ' 1 <br /> a �J <br /> t� < <br /> Date of staff site visit: ������Z/ Initials of site visit staff: �/ rii = <br /> 1115 <br /> //`` (A d n <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAyet..L... <br /> ( DATE: ��/ o < W v <br /> z m - <br /> v o C:=1 <br /> Page 1 of 3 rA o o <br /> Burnett County,WI Sign Application—Rev 12/2023 .'` f.12 <br /> o <br /> F <br />