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• <br /> SIGN PERMIT APPLICATION— Burnett County, WI aVq. z <br /> s <br /> Permit Fees: o• c <br /> 4. <br /> Off-Premise $100 2. ' <br /> d 0 <br /> On-Premise $50 .1, (�1'� <br /> ` c'Q <br /> Directional(Off-Premise) $25 J <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. _ OQ O <br /> Pi <br /> Applicant Complete All Sections Below This Line <br /> ' ". 0 e i <br /> Property Owner's Name: + y si <br /> p r <br /> Property Owner's Mailing Address: 019( Gc:�l,'v R D C V&ktbc' (A, fi160 o <br /> ;4 <br /> --� City State Zip <br /> Contact's Telephone Number: 7(6'3 " d-9 a— <br /> Contact's - b. <br /> Contact's Email: k-` cow. i' e ' 14,..., k . C GiV1 g 1& <br /> **If staff has a question about this application,you wilKe contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: @BurnettCounty W I.gov L <br /> Legal Description of Property: S 14-) t" tut—\/ C c c) R -e y �5Q1 (' ' �, <br /> `" a <br /> Section#: A)-- - Town#: LP N Range#: 1 W Town of: OL `lcrvc o .V <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 5' i c7 <br /> p (633 J C 6/0 �,) (,� 5e/t 3 d Nao <br /> Property Site Address: o <br /> 0 <br /> TYPE OF PERMIT(S): Check appropriate box/boxes o <br /> (%(,Off-Premise -Premise U Directional(Off-Premise) z. cA <br /> Sign Contractor: J e/► <br /> N -�t <br /> Anticipated Construction Start Date: -s <br /> N d v <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY r <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:y 1\\ <br /> ii, ti/ C Pi e-ed /79 ie- J - . — <br /> G1— /e,a S 3 1,--t `fit.e <br /> ar--+4 1/tit e. F C't.4 t. KC' C. <br /> le) -nt 1 ise:✓t/AA,'7�- /'S f r ,'l2,'IA / . e q u rti 7 r <br /> S 41 10, <br /> 441 e-s e. 5 mS C/S rl vH CIJo -� F : /5VP4114 <br /> J`, J_ t 9 r x Fee Rec. <br /> 1,9/A ell Tn'1 pi O d' Pt4 Pi C.� S cY /0D� e F Ck#: rm�19/o w atei <br /> 10'J per 30 -52 (? , <br /> z <br /> z <br /> x l , <br /> Dl <br /> Date of staff site visit: /2u'/2oa7' Initials of site vi ' staff: 7/d <br /> D U <br /> s�zo u U <br /> 0 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE: 3 r-,�,' <br /> uuu <br /> o t.n o <br /> Page l of 3 s.z <br /> N <br /> Burnett County,WI Sign Application-Rev 12/2023 rinni <br /> z <br /> J <br /> 6 <br /> '0 <br />