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9F/08/2005 08:23 3492188 B C ZONING PAGE 01 <br /> 86--0005 <br /> )Fees: 2 V <br /> Off-Premise moo Computer#: 3�"� a� (� 0p� <br /> On-Premise $ 50 <br /> Commercial Directional $ 25 <br /> BURNETT COUNTY SIGN PERMIT <br /> Applicant: q <br /> Address: '3 k 1 ( . }- ,0 ki 1 ii ID <br /> ...—.. <br /> Z I`tom lv+: A Mji , S5-'.3 Phone##: 33e - (c`i 3 . ( a--7 <br /> Property Owner: - al A'f ''-1 Og l S try)V <br /> Address: 1 CI 55. lifn cif L c • <br /> 1 <br /> Sign Type and Location lnformatiion <br /> Type: Off Premise P On Premise 0 Directional 0 ta - owczeateka outer` <br /> Town,( Section _ GL or 1/4 "/ Property Zoning <br /> Highway Road Name 71 Highway/Road Side N% S ❑ E ❑ W❑ <br /> Distance from Highway/Road Right-Of-Way 1 feet <br /> Distance between sign location and nearest road intersection is ).2.)3' feet. <br /> Distance between sign location and centerline of road/highway is SJ ' feet. ________ <br /> /. i 'VIA <br /> Distance from nearest existing off premise sign(off premise sign applicants only) � )`kA feet <br /> Number of existing free standing signs(on-premise only) <br /> I 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 I aan responsible for the detail and accuracy edit!! <br /> inforrnaiton 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 d , 'bed premises at any reasonable time for the purpose of inspection. <br /> Signature Applicant: CLS2-6 J ___/ <br /> Property Owner: See 444_ca nn9 ived Let-2 <br /> Sign-Information Required NFD <br /> AN <br /> SC <br /> Provide sketch illustrating the size(by dimensions),shape and message of sign. - akX tt :Zs!DZ <br /> Provide site plan drawing detailing location and positioning on property with referenced distances to property <br /> lines,road intersections,road right-of-ways and existing signs. �� \V <br /> S.1Y\ Z2 <br /> 4�0 ' --/`3-vim l ty. 3'�`' ��5, <br />