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SIGN PERMIT APPLICATION— Burnett County WI n <br /> 0. <br /> b <br /> it Tees:remise $lppemise $50 <br /> tional(Off-Premise) $25 <br /> *NOTE:After-the-fact(when no 2errnit is obtained prior to construction)is three times the normal fee. O <br /> `S <br /> Applicant Complete All Sections Below This Line <br /> Applicant's Name: 4M—Mm in AA- Lq CA,6 n 'Sbrr- �- kyr," °. <br /> r <br /> Applicant's Mailing Address: 3t)ZlI �I!/�tj�j"`J 35 `}7-7 D4ttlluJw1 (vj rj�}g3C <br /> City State Zip <br /> Applicant's Telephone Number: L-7I -7511 C:57 <br /> Applicant's Email:_ DG(P-h rl Sha b (61 h)r,:, bA ,h et <br /> 0 <br /> Owner Name: -"Il w <br /> 1 <br /> Owner's Mailing Address: '`Mq vC- <br /> City State Zip 7 <br /> o z <br /> If staff has a question about this application how do you prefer to be contacted? Check one below. <br /> Letter ❑Phone ❑Email <br /> Legal Description: /;;?F, QIPGtAkr d 44- Sechvvt 29 Tbtk.Yt 41 0 ) E IL, w) <br /> Lot#: CSM Vol. Pg. OR <br /> N <br /> Lot#: Block#: Subdivision Name: OR =' <br /> Gov't Lot#: OR 1/4 N 1/4 d <br /> �N <br /> J. <br /> Section#: 2 Town#: �� N Range#:_ (�_W Town of: �j._�q,�g5 W <br /> *Attach additional page r(needed for lengthy description OR attach a copy oj'the deed OR attach tax system property page. <br /> 0I-v32-2-Lfi -I(p -Zg-) 0 <br /> 4-oco-- 611oo0 <br /> Parcel#(24 digits): 0-7 -2' I :11y-Z 4-I 06r-006-c I LGco <br /> A7 nh7 L I II Z8 I h My C I'1G f� H <br /> Tax ID#(1-5 digits): 2Zc,7- 22- JZ Zd-15- <br /> Property <br /> 5Property Site Address#: a5&Zl 7 <br /> ii n z <br /> Road Name: S 35 +27 City:_ nettb4A ti z <br /> TYPE OF PERMIT(S): Check appropriate box/boxes <br /> ❑ Off-Premise On-Premise ❑ Directional (Off-Premise) / <br /> Fee Rec:-v-Co <br /> Sign Contractor: I" �� StC /l5 &,Aj Wby-t�JO-A J 5 <br /> M <br /> Anticipated Construction Start Date: t�OVLVIA hGL ) <br /> Z <br /> vim <br /> � O <br /> p SCENE z o <br /> NOV 2 2015 G) o <br /> 1' <br /> Page 1 of 4 <br /> BURNETT COUNTY <br /> Burnett County,WI Sign Application -Rev 3/2015 <br /> $ <br /> ZONING <br />