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Fees: ............... Stoo Computer#: - /qq-75-M-Graf <br /> err-rremi.c ........ !, <br /> On-Premise ................. . <br /> Conunercial Directional ._ S 35 6'/—D3o�- -�I'lty tncYJr"I-S-S -�c4101"'Q <br /> BURNEETT COUNTY SIGN PERMIT / <br /> Applicant /IJ/✓IU/tl/ h, 64 oyT/(o /�GP�l r2Ne <br /> Address: J753q Y �3 <br /> Phone #: <br /> Property Owner: 5'o'4P7rF-AS /-IfJFJ�tedN� <br /> Address: <br /> Sian Trne and Location Information <br /> Type: Off Premise ❑ On Premise I Directional ❑ <br /> Town StV I S S Section a GL or Y '/, coperty Zoning <br /> pp La75 713-, p ezfs�Y-RztJ'rfiiei. <br /> Highway Road Name�ticC S joa,(Urs-/ Highway/Road Side N ❑ S ❑ E W ❑ <br /> Distance from Highway/Road Right-Of-Way _10 feet <br /> t <br /> Distance between sign location and nearest road intersection is feet. <br /> Distance between sign location and centerline of road/highway is 35' feet. <br /> Distance from nearest existing off premise sign (off premise sign applicants only) /VA 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 detail and accuracy of all <br /> inform niton contained in this application(including any accompanying schedule)and I further declare that I recognize that <br /> this iolimn:nion 1 am providing will be relied upon by the County of-Burnett Wisconsin in determining whether to issue a <br /> permit. 1 further accept all liability which may be a result of the County of flumett relying on this information 1 am providing <br /> in this application. I agree to permit county officials charged with administering county ordinances or other authorized <br /> person to here access to the above described premises at any reasonable time for the purpose of inspection. <br /> Signature Applicant 0Uj <br /> er: , <br /> Property Own .x C <br /> Sign Information Reuuired <br /> Provide sketch illustrating the size(by dimensions), shape and message of sign. <br /> 11rovitle 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. <br />