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SIGN PERMIT APPLICATION— Burnett County, WI a n <br /> y. z <br /> Permit Fees: o <br /> Off Premise $100 <br /> c <br /> On-Premise $50 / <br /> Directional Off-Premise) $25 V <br /> *NOTE:After-the-Fact when no permit is obtained prior to construction is three times the normal <br /> Applicant Complete All Sections Below This Line <br /> n <br /> Applicant's Name: Fok iA-j,, S b u P <br /> Applicant's Mailing Address: QA w ,v�% Y Q b ro c,J vvc,,, AIS Z L o <br /> City State Zip <br /> Applicant's Telephone Number:_ W12 - ,P Z S - 2o-73 MP`5, M A/ <br /> b_3-y Z 7- <br /> Applicant's <br /> Applicant's Email: 'AP-1 <br /> 1 r- d XIVe (4) -Pti , ttns 1 bil e , O g <br /> Owner Name: r-G i t h I L o j 4 e <br /> Owner's Mailing Address: r) <br /> City State Zip <br /> 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. ` <br /> ElLetter WhoneO r 9Email <br /> Legal Description: <br /> b <br /> Lot#: CSM Vol. Pg. ORbe-tow o °o <br /> Sae m�P <br /> Lot#: Block#: Subdivision Name: OR W <br /> Gov't Lot#: OR 1/4 1/4 ` <br /> 5. <br /> Section#:. Town#: N Range#: W Town of: v <br /> *Attach additional page ifneeded for lengthy description OR attach a copy of the deed OR attach tax system property page. <br /> Parcel#(24 digits): L,�` C, <br /> 1 W <br /> Tax ID#(1-5 digits): L rope` i`� Irlt"4 �\ <br /> Property Site Address#: wC^Re e O-� c4-y Rd U &tom. C L' N/ <br /> z <br /> Road Name: G4�- (A City:D A n bL, W Z <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> F <br /> J Off-Premise J On-Premise Directional (Off-Premise) Fee Re( y <br /> , tt -- x <br /> Sign Contractor: S; 4 V\ W ,1 0 v�- V -1" G ryu.-J, y <br /> kee P r of � *AJ L-04t z C <br /> ' -A=te <br /> Anticipated Construction Start Dat : 6eyT r_ C' e,tV o- ZO L z M1 r� <br /> c' Z c <br /> M <br /> C- ifj (A S;yh wale yo n o <br /> 0 <br /> Qe) <br /> b R' Page 1 of 4 c C7 <br /> -j2 <br /> \ � u Burnett County,WI Sign Application-Rev 3/2015 <br /> cT <br /> �% r m <br />