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0 <br /> SIGN PERMIT APPLICATION— Burnett County, WI aR z <br /> cn <br /> Permit Fees: '= o <br /> a 1 <br /> Off-Premise $100 <br /> ,i-:;,-':'' <br /> On-Premise $50 a <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 /> n '.-!.() (--r-- <br /> Property Owner's Name: i(2r4ce (C•4., r <br /> a <br /> Property Owner's Mailing Address: ; _ _ , „, f „� ,f, , ,„ -, _j SI. , 0 ' <br /> City tate Zip i <br /> Contact's Telephone Number: 7/5".-' 4/1 6— 0135— (se...ruz.e.) <br /> Contact's Email: "*424 6 -ICJ C t6 var • &WI% 1 <br /> ��11,� <br /> , ■, <br /> Legal Description of Property: �'/0" Ai- /4" q b3 -oat,-- to lived d <br /> Section#: I{D Town#: /Y N Range#: g W Town of: •p 4+ n <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* 4 <br /> C <br /> / 0 <br /> Parcel#(24 digits): '{O "I y" / b " 't D 3" ��'� Q !/ill 04, <br /> Tax ID#(1-5 digits): age N'?S i ,3 u <br /> Property Site Address: 2 ago deon J . <br /> 1'R 4 S�jner', a2 1 N0.„ <br /> a <br /> TYPE OF PERMIT(S): Check appropriate box/boxes o <br /> 5. <br /> ❑ Off-Premise xi-OnPremise ❑''Dl!irectional (Off-Premise) <br /> Sign Contractor: T €- s4.i'uc.Ko"__ <br /> Anticipated Construction Start Date: Sep T Is, p'ZO3o -., X <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> — <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BLOW� p7.. <br /> m '';'1 �� <br /> I/2; °.�� Af8 G E �� C n z <br /> • Ak4k.,1 G u. S. (\ Cr re_c 0 1a l I A.CeS 407`® <br /> e)cceed 4,2o f' <br /> 6 5e-1- ba,ck. --P (Com g c,tbnAiikect pisf gam <br /> • L-,-400k-t- Yes) NT6 6 -Pa-5b 0 r rove • 1.29\-k`,,n (►\ x Fee Rec45' <br /> �'c"P Cl.- 395 <br /> to <br /> c da�� Q� �!I I, c_ co <br /> Date of staff site visit: Initials of 'te ' it staff: d' _ r <br /> a D' <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: ' e1 ' ' • <br /> , 3 <br /> i `D5 <br /> C <br /> > m _ <br /> t1 . 0 w <br /> 07 C <br /> Page l of 3 p) i <br /> Burnett County, WI Sign Application—Rev 1/2020 2 <br /> 0 <br />