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SIGN PERMIT APPLICATION—Burnett County, WI a z <br /> Permit Fees <br /> Off-Premise $100 <br /> On-Premise $50 <br /> Directional(Off-Premise) $25 <br /> *NOTE:After-the-fact(when no pennit is obtained prior to construction)is up to three times the normal fee. <br /> Applicant Complete All Sections Below This Line <br /> O o <br /> Property Owner's Name: 'rtCt�tiCC�V�f &x (�`�'c, � CCZ ►ti - <br /> Property Owner's Mailing Address:__-� "- -e V W T 1 a <br /> City State Zip <br /> Contact's Telephone Number: 2-2 Z <br /> Contact's Email: �A,,S VAC C?Ci SCE Y e.� C' t\&-f) C 0 V" <br /> **If staff has a question about this application,you will be contacted via email. Make sure your email address is <br /> legible and your email provider will accept emails from the following address: (d,BurnettCountyWl.gov DD <br /> Legal Description of Property:��L S ESQ <br /> ' g <br /> Section#: © Town#:' N Range#: ( W Town of: yL0 An0 <br /> *Attach additional page if n�ee�ded forr lengthy description OR attach a copy of the deed OR attach tax s}stem proper•tt'page. <br /> Tax ID#(1-5 digits): r -Q7 <br /> Property Site Address: <br /> 5' <br /> o� <br /> TYPE OF PERMIT(S): Check appropriate box/boxes d <br /> 5. <br /> ❑ Off-Premise ` '6-on-Premise, ( ElDirectional (Off-Premise) <br /> b <br /> Sign Contractor: o r I�V kc, V� <br /> l <br /> Anticipated Construction Start Date: d <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTEP BELOW: <br /> /J // to q7 o z <br /> IM 1, V •� �J ^O 1 v <br /> Z f D �?C s f2L Lrfs Zvi <br /> Fee Rec: - <br /> f Ck#: (� <br /> D <br /> Z <br /> Date of staff site visit: �i f l� ZV Z� Initials of sit isit staff: /. Z <br /> cn m CL <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:3��� = CD < <br /> .. G <br /> 7. nCD <br /> CD <br /> 1L� <br /> 0 0 <br /> Page 1 of 3 N C <br /> Burnett County, WI Sign Application—Rev 12/2023 -� <br />