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Sign PBrmrt_Asa-aoo <br /> PC,,, <br /> Computer#:ercial Dirrelinnal ... <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: r <br /> Address: �'-h'�L2e.. t <br /> cry)". A!_ MIJ 1351d2� Phone#: <br /> PropertyOwner: '�� l llf`-k cai 13a K) <br /> r�(048 <br /> Address: --f� —A-`-� M>.r [+dpnrt IAIT5"M37 <br /> __L�.Cav'��In..l-i�✓.� w I r��r�—'tet � <br /> Sign Tyne and Location Information <br /> Type: Off Premise ❑ On P mt eT� Directional ❑ Lv7 I e5/11 ✓ '�- a7q <br /> iss-NIN 1Z � C- I <br /> Tow Section al�L_ GL_orN5_C__r/. 114 Property Zoning <br /> Highway Road Name Main Highway/Road Side N ❑ S ❑ E ❑ W ❑ <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[me.correct and complete. I acknowledge that l am responsible for the detail and accuracy of all <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> (his information 1 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[his 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 reaso'1J�b]e time for the purpose of inspection. <br /> Signature Applicant:"�"lQt-, <br /> Property Owner: <br /> Sign Information Required D M RD <br /> Provide sketch illustrating the size(by dimensions), shape and message of sign. JUL 1912013 <br /> Provide site plan drawing detailing location and positioning on property with referenced di,K)RNEMPOWNTY <br /> litres,road intersections,road ri and existing signs ZOI'i1i <br /> / / /J/�J,�v.a/ g- ao-I3 <br />