HomeMy WebLinkAboutPermit Permanent Sign SN-11-47 - DR. HEATHER DIEDRICKBack to Wellness
802 864 4959
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Permit NuiriDer SN- -
City of South Burlington, Vermont
Application for Permanent Sign Permit
1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #)
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2) APPLICANT (Name, mailing address, phone and fax
3) SIGN LO,CIATI`O1,N_ (inctude business name, address, & phone #):
4) TAX PARCEL ID # (can be obtained at Assessor's Office) � 0
5) SIGN ERECTOR (Name, mailing address, phone and fax 4): -.
7) DATE OF ERECTION____.___
S SIUN DATA
WALL SIGNS (list, size in sq. ft., illumination, &
typeTP_RE_E%ft
srcN h aspaneloreut-om letter)SIZE (in sq,
D / r'� l C i� 1 �( OVERALL HEIGHT:
S[�V1T�LL Al in .Qft.j- TYPI: 4F ILLCTlV�� N_
MOTE_ A scaled rendering of proposed sign be submitted illustrating the colut of the siga and
noting the dimcnsioas of each sign.
9) DATE OF DESIGN REVIEW APPROVAL (if applicable):
IU) Applicant SiVature:
11) Signature of I.andlButlding Ouxn
Date: _ t-2 -
mate: (41(_
................................. ...........................................
t)o not ri below this line
o LO y-
Fee: p on: ej cted pprove
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Code Officer Signature: Date.:
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t Ur_ "-ihrr, L Died-wh
s� er a ro wT�ivc s � H�aora eau
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3681
Good HEALTH
DIAGNOSTIC CENTER, INC
Dr. Heather L. Diederich
BACK TO WELLNESS CHIROPRACTIC
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