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n c .c <br /> SIGN PERMIT APPLICATION — Burnett County, WI s i z <br /> Permit Fees: a Z 4\ <br /> a <br /> Off-Premise $100 <br /> On-Premise $50 <br /> Directional(Off-Premise) $25 VC3� <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. N i <br /> 4 <br /> Applicant/ Complete All Sections Below This Line <br /> o <br /> Property Owner's Name: NO r ii kre,S Pas'�a G J2i <br /> r el <br /> Property Owner's Mailing Address: I 7 N, 84.SS 1.0 41 Gtl(��'_oei• tvi ��a5Ilk <br /> 1 -, <br /> 0 <br /> City State Zip g <br /> Contact's Telephone Number: -7/S - (7s C1 I tG J_' - l 0 <br /> ,9 r <br /> Contact's Email: tACA V k e @ /1 L I p I1 Ol, , c V'e: ° Ov <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is W <br /> legible and your email provider will accept emails from the following address: @BurnettCountyWl.gov <br /> J! u O <br /> Legal Descri tion of Property: L°t—3 C S M it 1 D:114 vc. f `f. C f Ei N ) l j✓o n j <br /> Section#: �a t, Town#: ¶3 j N Range#: R 1(0 W Town of: PI P.c?11 c 't., c <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> Tax ID#(1-5 digits): 1 1 ( 1 <br /> b <br /> tio <br /> Property Site Address: cCt4M-Q., a c t it>0 U e,.'` oN <br /> o <br /> o <br /> acz <br /> TYPE OF PERMIT(S): Check appropriate box/boxes dam` <br /> 0 Off-Premise On-Premise ❑ Directional (Off-Premise) <br /> —r-. / �AIi° n o <br /> Sign Contractor: 1 A h er14 , L fa,l I d 1 i� 4 MA I Q A tl%t.LL. <br /> Anticipated Construction Start Date: J(.w•.t 2 _ d <br /> W <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: A <br /> 6 TA e- /-eS4 ors 7�G,5 5-tgyl does n exce-e.Z 8'D si x <br /> • 50 /t74- /tS 0//cGJ e-dt. <br /> 13 Fee Rec: S�• <br /> N Ck#: 6'737 <br /> r7 <br /> rn <br /> r- <br /> a <br /> z <br /> x <br /> ? < w <br /> Nll <br /> Date of staff site visit: 5'�S W Z� Initials of site visit staff' i T. <br /> 0 coX <br /> �� 0 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: �7 ZOLy Q <br /> 0 !Ng <br /> ' ®c ~ c� <br /> Page l of 3 ; < <br /> Burnett County, WI Sign Application -Rev 12/2023 <br />