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SIGN PERMIT APPLICATION - Burnett County, WI . z <br /> z. I N <br /> Permit Fees: 0 n c <br /> CD 1 <br /> Off-Premise $100 p e <br /> On-Premise $50 <br /> Directional(Off-Premise) S25 <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 /> E) ve a <br /> Property Owner's Name: V09 GL si, V I I I a & e_, o ` <br /> Property Owner's Mailing Address: 2 fr 51 K. /k=G(f to /2C ,DA-Nb ury /HO r <br /> City State Zip <br /> Contact's Telephone Number: 7 15- i4'1 1p - 25- k" r <br /> Contact's Email: jFA-S KyP Ce v.Ta r21+-e,I , iit: ° , / <br /> Legal Description of Property: OO'NO 143 —. e-e-- 7)c 1c . ; <br /> Section#: Town#: N Range#: W Town of: -1444.5011 f SG d e n <br /> cn <br /> *Attach additions pagedneeded or lenphty des iption OR attach a copy of the deed OR attach tax system property page.* 4 <br /> 5e-e-- 1 j/ ! • - etc- Sew,/ S eG 7 - sGol( o <br /> Parcel#(24 digits): 5e,G_ -1-4.44 k:/..i : be-/c aim <br /> q / 'l 33 , q <br /> Tax ID#(1-5 digits): !136 6if 8.D/ 77 177 5 I775a f /0?, <br /> �,� <br /> Property Site Address: cCIO <br /> C <br /> S. <br /> TYPE OF PERMIT(S): Check appropriate box/boxes o <br /> a, <br /> J Off-Premise ❑ On-Premise )(Directional (Off-Premise) = c„ <br /> Sign Contractor: <br /> Anticipated Construction Start Date: x <br /> �1 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY 6-4 <br /> 4)THIS PERMIT IS SUn'ECT TO ALL CONDITIONS LISTED BELOW: CA1 <br /> ' ' eieIMt.71S 4y 6 si- NS. c� z ,. 0,,‘ <br /> 1 Tx ,a- 9130 - CG►Q 1 ed- i, SAos� A. - 3 3 1 ..6,0m e P. ,.D <br /> z, 7 ,d: 61/86 - Cj i/e - Rd,' �B yca'9'Ev' • -33 - '630tH p <br /> 3 7 x /,s 2, ._ IRG►l ka rma Rd t Us yapu^Rd - 3 3 c-f- 40'44 <br /> q, 1;4)c ,1 r 79 yc - cKA-ewe- <br /> //y /Rd /4 t',SA.,,/r� - 3c-P/-- ,,i s Cs%ie.K\ Q5`P <br /> 5; Al - 7752 — K �k e-,d 1 /'7 A)t�f1' t*A rtht om - 331Y 4.4 ..... Fee Rec: <br /> fax ' ' y � �-�3? (� <br /> . 7 i;"; f0 - CJ,4iSRI 4 4h i qc uq/C gid 33-r7t ryosi �� <br /> a <br /> o <br /> Q ��7 m <br /> Date of staff site visit: v 2i �!� Initials of site visit taff: / / x w <br /> 511 <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL: DATE:S/2/20ZOD -,c r 0 <br /> 0 m � <br /> i <br /> Uuu <br /> Page l of 3 k 3' o w <br /> Burnett County, WI Sign Application -Rev 1/2020 < cA <br /> -i <br /> a <br /> 4 <br />