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cy dariNt&ow, <br /> APPLICATION FOR A SIGN PERMIT, DANE COUNTY, WISCONSIN PERMIT NO. ' `' a > <br /> The undersigned hereby applies for a permit to erect a sign as described below. if. - :.?> <br /> The undersigned declares that the statements made below are true and that the FEE . <br /> proposed sign and its location are all in full compliance with all laws and ordi- <br /> nances applicable thereto. <br /> 'Town _`/ /1/% 1 D f -1 O7O .:5A4')/ `1(4,-rrf > Section (01/4 1/4 /d- <br /> Lot Block Subdivision (..1i"-1 ' L / <br /> Land owner Sign owner <br /> ( 1 1(. / /."1 )�Il<//'L%;. iv V`f l tom'" 111i1({l (40lf,(� <br /> ) . t /(/ 7) <br /> //1/96 (,)/,- r`.u�/ > 71 <br /> Zoning district Sign to be installed by <br /> Type of sign LrtJ 1` is 1� 1 j t / l /.�. I))ux{,11 v1( ti <br /> � r � 1 <br /> Dimensions / �t '.. CC{ A. U '7 r; ii) / <br /> Square feet � c.. _Cost 40� r.1 _ .1(.art (:4 )-O) <br /> Copy Location <br /> 0 <br /> a <br /> a <br /> . .a <br /> 1 <br /> a <br /> Road l\JO1) <br /> /-/! //1(4 f 7t", <br /> Show location of this sign by "x". Show location of any adja- <br /> cent signs by "b". Show distances from nearest intersection <br /> Applicant and adjacent signs. <br /> ((( ;.. I( Mx _ <br /> Signed <br /> Permit issued /1(--)-- / .' )U ✓� Inspection <br /> Date By <br /> ,Toning Supervisor <br /> ,5-111(2195) <br />