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SIGN PERMIT APPLICATION—Burnett County,WI a- 1 z. = z <br /> N <br /> Permit Fees: C co <br /> Off-Premise $100 a n. <br /> On-Premise X $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. ..iJ i <br /> Applicant Complete All Sections Below/ This Line <br /> Property Owner's Name: ir:7 _ �1bn 1E N-�— .: \.) <br /> ,•r,,` r�� o N <br /> Property Owner's Mailing Address: X1160 3S VVE , . 5%WI 3 o <br /> City State Zip V <br /> Contact's Telephone Number: 1(5 -S1,6- 41 gi <br /> Contact's Email: 1(�L.e 14'0 7X-1 4SG11.Prvet.- W 7V\ • <br /> r 1 <br /> Legal Description of Property:y � pa.s/ol1 f 411-4991- Ex Csrni I7 p 151 ,M <br /> Section#: hS Town#: N Range#: f Co W Town of: O1.�.AN0 , I, .^ <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* r <br /> �7 0_ tb <br /> Parcel#(24 digits):01-0 i0 2 "«o' i-g'3- C 0c0 01 j0� <br /> Tax ID#(1-5 digits): 13'7 9 3 r <br /> Property Site Address: `'iR"%`,`-/��{, �� P- *-.n"\-r1 a‘A-c-e' N °0 ' 7 <br /> a C <br /> ... <br /> so <br /> TYPE OF PERMIT(S): Check appropriate box/boxes G ' e S <br /> 5. <br /> ❑ Off-Premise Xi On-Premise ❑ Directional(Off-Premise) 2 rn <br /> Sign Contractor: <br /> Anticipated Construction Start Date: y}'lL SOSO <br /> o <br /> 0 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS Sy.,BJECT TO ALI�CONDITIONS L ST D BELOW: CN. <br /> /; <br /> I <br /> Fee Rec:'ii5-D(.O <br /> 5 1: .2. w <br /> to <br /> E <br /> Date of staff site visit:�' ��c),:;,)- � m <br /> Initials�f site visit staff:�) L < r �t <br /> PERMIT APPROVED BY LAND SERVICES OFFICIAL nt��'`i "DAT U' <br /> Co co s m - \ ! <br /> 0 <br /> Uo � <br /> z <br /> K y n V <br /> Page 1 of 3 0 �c ry <br /> Burnett County,WI Sign Application—Rev 1/2020 <br /> cA <br /> mgiil <br />