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SS—ao�3 <br /> Pees: <br /> Orf-Premise ....................... $100 Computer#: <br /> On-Premise ...................... S So .rte <br /> Commercial Directional ... S 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: i' - Ssa <br /> Address: 7x///7 /V, acts., L.t- G <br /> Phone#: 7/S" y9I"GL�Id <br /> Property Owner: Alo✓'l{,,.,iL Paj;S ,cam <br /> Address: <br /> Sien Type and Location Information <br /> Type: Off Premise 0 OnPremise)sf Directional 0 Lot3 csml/- lo Pa4a-- yNR�I'✓ <br /> Town Me a to tri Section :ic) GL_or NE y. YE '/. Property Zoning <br /> Highway Road Name 35 Highway/Road Side N 0 S 0 E 0 W,K <br /> Distance from Highway/Road Right-Of-Way /03. feet <br /> Distance between sign location and nearest road intersection is /6Sr feet. <br /> Distance between sign location and centerline of road/highway is //7 feet. <br /> Distance from nearest existing off premise sign(off premise sign applicants only) NIA feet <br /> Number of existing free standing signs(on-premise only) <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the derail and accuracy of all <br /> informaiton contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a <br /> permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to have access to the above described premises at any teas ble time for the purpose of inspection. <br /> Signature Applicant: Z <br /> Property Owner: <br /> All n- <br /> Si2n Information Required OCT 1 2013 <br /> Provide sketch illustrating the sin(by dimensions),shape and message of sign. SURN77ErrT�1T1�tcouNTY <br /> Provide site plan drawing detailing location and positioning on property with referenced distal) ONgroperty <br /> lineA,road intersections,road right-of-ways and existing signs. / <br /> � 5le-1 oh Zdc4 <br />