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.f <br />SIGN PERMIT APPLICATION — Burnett County, WI <br />Permit Fees: <br />Off -Premise $100 <br />On -Premise $50 <br />Directional (Off -Premise) $25 <br />*NOTE: After -the -fact when no permit is obtained prior to construction) is up to three times the normal fee. <br />Applicant Complete All Sections Below This Line <br />Property Owner's Name: �04r�� (:U m R L l L.L C Lu i id, Aj ood <br />t, <br />Property Owner's Mailing Address: 4054 o Ia �� z� �G �+� r k)) 45`yg5y <br />City State Zip <br />Contact's Telephone Number: �13- y5'7 -,-y75 <br />Contact's Email: j p 60 tt,� M!X& VA h 00, u) M <br />Legal Description of Property: .:2O / A 1f 16 of � d 7 <br />Section #: Town #: 7 O N Range #: /jo W Town of. dG <br />*Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page. <br />Parcel # (24 digits): �� �� Q '�� - y ^ �tti ' Z Q Z 0 3', 000 -y ! -00 6/ <br />0Z-W0- OlzVvd <br />Tax ID# (1-51diigitsf : 1 3�� 1- i3 VW <br />Property Site� Address W l lc(0 t wm/ ist�i <br />TYPE OF PERMIT(S): Check appropriate box/boxes <br />Off -Premise 4 On -Premise ❑ Directional (Off -Premise) <br />Sign Contractor: ��iGf, �I�i�i <br />Anticipated Construction Start Date: <br />AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br />THIS PERMIT IS SUBJ CT TO ALL CONDITIONS LISTED BELOW: <br />� T <br />/ 0' e. O/ <br />t 1 /1 D 4l7 Y` W �lti1 <br />ah' G <br />Date of staff site visit: S l / Initials of site visit staff: " <br />PERMIT APPROVED BY LAND SERVICES OFFICIAL: 9DATE: <br />Page I of 3 <br />Burnett County, WI Sign Application — Rev 1/2019 <br />et <br />O <br />a <br />r <br />CD <br />I <br />Qn <br />c <br />z <br />cJ� <br />Fee Rec: <br />� 9&-7 <br />su <br />a <br />uuu <br />tn� <br />m <br />3> <br />U <br />cc <br />�c <br />o <br />o <br />3 <br />cc <br />it ltl <br />