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SI- RDO <br /> Fees: <br /> Off-Premise ....................... $100 Computer#: 00-4333-0'-1-900 <br /> On-Premise ...................... $ 50 <br /> Commercial Directional ... $ 25 <br /> I, //� ,�� Bi_JRNETT COUNTY SIGN PERMIT <br /> K <br /> Applicant: CZ Fox L1,C J loo, Fox Qm GO 1-F COure, <br /> Address: I 5�5(p 3+a1—e, :koo—J 3 [I-> i5bX 15G <br /> \�b,5fer IAJ-t �(4P3 -I 2_p Phone#: 715-% <br /> /1 (c-75 <br /> (Property Owner: Kevin `i- AmY F_, Q I III(z ncL <br /> Address:) d o� Cb Un fvljGZ Gtt <br /> Danbury LA)--F. 5q �3 <br /> Sign Type and Location Information <br /> Type: Off Premise ❑ On Premise ;, Directional ❑ <br /> TownOa.klanc Section 33 GL orNW'/</\j V4 ''A Property Zoning n <br /> 1 <br /> Highway Road Name STaTF&AD 2 JCH) Highway/Road Side N ❑ S ❑ E ❑ W ❑ <br /> Distance from Highway/Road Right-Of-Way Q_feet <br /> 10 <br /> Distance between sign location and nearest road intersection is 556 feet. <br /> Distance between sign location and centerline of road/highway is 90 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) —U—MOV I nj curren+ s ii n) <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. 1 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. 1 agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above descri ed premises at any reasonable n purpose of inspection. <br /> Signature Applicant: - <br /> Property Owner: eV I n C � 21 I Vl <br /> Sign Information Required <br /> Provide sketch illustrating the size (by dimensions), shape and message of sign. <br /> Provide site plan drawing detailing location and positioning on property with referenced distances to property <br /> lines, road intersections, road right-of-ways and existing signs. <br />