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HomeMy WebLinkAboutPermit Permanent Sign SN-04-31 - CHAMPLAIN OIL1) OWNER OF L)E_�T_�1I`T`�' !� FL'3��TT1'1PTu T : "o1 TAT iF 575 DORSET STREET SOLD BURLI_�T TON, VERMOINT 05403 (302) 346-4106 FAN (302) 346-410-L Permit Number S1\T ov --� Application10r Pe anent Sign Penn (Name as shown on deed, mailing address, prone and fax 9) ?) APPLICANT (TTan e, mailing address, phone and fa #) IGN LOCATION (include business name, address, & phone #): I 6 D " 7 �%-2 4) TAX PARCEL ID # (can be obtained at Assessor's Office 5) SIGN ERECTOR (Name, marlin l l^") M 1 J f. Cy Ij VN �_ 6) DATE OF ERECTION 7) SIGN DATA T� N phone and fax #): � 11 eLc poo WALL SIGNS (list size in sq. ft., illumination, & type such as panel or cut-out letter) FREE-STAI` iNG SIGN 1. 3 - SIB (in sq. ft.): 2 • O' TERALL I IEIGHT: SIGNABLE WATT . AREA (in sq. ft.): TYPE OF ILLUMNATIflAI: iV O H: A scaled rendering of each proposed sign must be submitted illustrating the color of the sign and noting the dimensions of each sign. S) DATE OF DESIGN REVIEW APPROVAL (if applicable): 9) Applicant 1*,nature: Elate: /2- �e0 .��--�► 10) Signature of Land/Building Owner: ��� �% ��,---g Date: z a y ®Q6NRaQ99®09U'OBV®6000®O..... ]a]©BQMQQa..... Q.na.nnnnnn.,.�nnnnor,.,.,.�.,m......,..e..,.s.....e.,.,...,�............�...................,..... .. Do not write below this line F e--: Q/ 6190,—Code,—Code Officer Signature: 4- Date: