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SIGN PERMIT APPLICATION — Burnett County, WI a z <br /> Permit Fees: <br /> Off Premise $100 <br /> i <br /> On-Premise $50 d <br /> Directional Off-Premise $25 <br /> *NOTE:After-the-fact when no permit is obtained prior to construction)is three times the normal fee. <br /> 0 <br /> Applicant Complete All Sections Below This Line <br /> OQ <br /> C) <br /> Applicant's Name: /� <br /> Applicant's Mailing Address: �� /7Gf/SD/5 iL0 <br /> City State Zip Q <br /> VIC <br /> Applicant's Telephone Number: �/3 ZIoG <br /> Applicant's Email: �r t c�ae5q 6.h oy a r coeln °^r <br /> Owner Name:fzs9-l/la 12GK,0AZf-K. <br /> Owner's Mailing Address: Z�� �'t>oNG./ /-Anrc ) Or49 14/, <br /> City State Zip z <br /> 0 <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> ❑Letter hone ❑Email <br /> Legal Description: K T-r#-e-*a <br /> b <br /> Lot#: CSM Vol. Pg. OR c oe <br /> 7 <br /> Lot#: Block#: Subdivision Name: OR <br /> Gov't Lot#: OR 1/4 1/4 <br /> N_ <br /> a. <br /> Section#: Town#: N Range#: W Town of: v, <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 1 21- <br /> Parcel#(24 digits): 6-7-0 - Z-1f c) 'l 4-3 03 -6o0 - p//o o o <br /> H <br /> Tax ID#(1-5 digits): / $ p Z3 <br /> Property Site Address _ Z <br /> Road Name:-&U t _City: -5j2 pbwl Ce- W I y <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Off-Premise ❑ On-Premise ❑ Directional (Off-Premise) Fee Rec:2- � <br /> -i <br /> Q S <br /> Sign Contractor: I� hl`�FkDP �(a W�zJ �� �T- ULoorrtt�Gtnil M h/ o <br /> m <br /> 5sy� o <br /> z (A �•�J j <br /> Anticipated Construction Start Date: o C <br /> a <br /> D <br /> �N c <br /> oz O RI c' <br /> -C ZZ _--il ��- <br /> A^ A �' o <br /> CD <br /> mY,�j Q <br /> Page 1 of 4 o C -}l- <br /> Burnett County,WI Sign Application—Rev 3/2015 <br /> 3 <br /> o <br /> x <br /> M <br /> A <br /> m <br />