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Sign Pe 4S -01ol5 <br /> Fees: <br /> Computer#: 53a$� - <br /> n-Premise $ so COMPUTER/SCANNED o1 o -q1�(O:/- D -oa a <br /> Commercial Directional $ 2-5 U <br /> 1 <br /> BURNETT COUNTY SIGN PERMIT o <br /> w <br /> Applicant: t .�:AVVYe.. c„,v—. ;'‘' \--' <br /> Address: y C <br /> '� n .y... _ 1 S Phone#: ( Si- 44 -'lr7 1/1 <br /> Property Owner: `"-ex-1--ea-" 'Th _....--. 6 'LAnlef (0,1 Pan 10 <br /> j� Pog <br /> Address: -I 4- NA ,tr, `-- ` E.- FrPd-.n'c)1n1T 5483`7 <br /> <---_- -?:erx --v1,--D v•-t2„,Ly--: 1 -S-TC-37---2 ) <br /> Sign Tyne and Location Information <br /> Type: Off Premise ❑ On P emi e Directional 0 �'7 I �'S in V 7q <br /> isTiiN go A � <br /> Town tA- Section�.R GL or5E 1/4J'E t/a Property Zoning C' I <br /> Highway Road Name Mai n st. Highway/Road Side N 0 S 0 E 0 W 0 <br /> Distance from Highway/Road Right-Of-Way feet <br /> Distance between sign location and nearest road intersection is feet. <br /> Distance between sign location and centerline of road/highway is feet. <br /> Distance from nearest existing off premise sign (off premise sign applicants only) feet <br /> Number of existing free standing signs (on-premise only) <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> informaiton contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> Signature Applicant: CX -�-, N v-�, ,--'� <br /> Property Owner: J <br /> Sign Information Required R <br /> ECEOVE <br /> Provide sketch illustrating the size(by dimensions), shape and message of sign. J U L 1 9.2 013 . 1) <br /> Provide site plan drawing detailing location and positioning on property with referenced distBuRNEripeouNri, <br /> lines,road intersections,road right-of-ways and existing signs ZONING <br /> 7 /.4 .-N <br />