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SIGN PERMIT APPLICATION - Burnett County, WI a g <br /> Permit Fees: °' c <br /> CD ' <br /> Off-Premise $100 <br /> On-Premise 6;0_..) w <br /> i9 <br /> Directional(Off-Premise) $25 <br /> *NOTE:After-the-fact(when no permit is obtained prior to construction)is up to three times the normal fee. <br /> Applicant Corn lette,All Sections'Below This Line <br /> Property Owner's Name: �;; re, �/1 (ale o ilk <br /> a 2 r <br /> Property Owner's Mailing Address: 25-1 N 7 5 Rd.35, 5 1 w) o o , <br /> � City Statee Zip <br /> Contact's Telephone Number: 15 — 71 -Loci' `/r� J �3 <br /> (( i• ' <br /> Contact's Email: el STACIE Y -'OC) . C o o 4, <br /> hie Nl✓ d FAJ4 viLT of- txT 3 C&M 480) <br /> , <br /> Legal Description of Property: L01- 2 CSM V ti P l9 FX t{W y DISC 107/Si 4 11815 r <br /> Section#: S2.0 Town#:73111iN Range#: ? no W Town of: Meet O f n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* C <br /> 0 <br /> Parcel#(24 digits): 07 ^ Qt$ 2- -S9.- I to-2-0- 1 O I-OCO -bre OQQ© <br /> Tax ID#(1-5 digits): 1 RC ..J <br /> 25941 S L <br /> Property Site Address: 'TQ-4-e. Rd 35c w <br /> TYPE OF PERMIT(S): Check appropriate box/boxes °° <br /> 0 <br /> 5. <br /> ❑ Off-Premise X On Premise CI Directional (Off-Premise) ,-, z <br /> Sign Contractor: Si--('QCo <br /> Anticipated Construction Start Date: D OF M..)NE -AS Soon aS vie e ,-3q � x <br /> ct�Q <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS-ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: `1 <br /> f z CI <br /> e@ `� I i i <br /> close r tila ,, /0 . a". ..' 4.-}0.1n 5 \\,,3 <br /> -P uu ,,,,, <br /> • '0\10\A) pio-\- la vx c` r 1 / / ROLL ce h— cl 7 <br /> x Fee Rec: 2 - <br /> nn <br /> a <br /> Z <br /> Date of staff site visit: —11 d`��Initial of sit isit st ff: \L- CI 0 (� <br /> C a L.- <br /> PERMIT APPROVED BY LAND SERVICES OFFICIA 7 � rz.`� <br /> 0. <br /> a w1 PO <br /> Z0 CI°c LSI <br /> 3 1 < <br /> Page l of 3 a1 �U <br /> Burnett County, WI Sign Application —Rev 1/2020 2'' L . <br /> 0' <br />