HomeMy WebLinkAboutPermit Permanent Sign SN-11-22 - SURGI-CAREu41z71ZU11 08:23 J.L. DavisReaty
Rpr 26 11 03t19p Kershner Signs
(FAX)802 879 0553
802 658 6357
P.0021002
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P=Tdt Number SN- ' ' rA
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City of South Burlington, Vermont
Application forP=Tnanent Sign Permit
RECORD my ae shown ozl deed, mailing address. phone and fax #)
31 SIGN LOCATION (includebusjuess name, addrosq, & phone # : �-;
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4) TAX PARCEL ID # (can be obtained at Assessor's Office)
5) SXGN ERECTOR (Name, mailing address, phone and fax #): ,vC IKL +—___
7)'DATE OF ERECTION 0
8 SIGN DATA
WALL SIGNS (list size in sq. ft., u mimciory & type FRM-ST=] 1�1 SIGN
such as ansl of mt~out letter
I SIZE (in sq. f : _
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2. Vl?RALL I -MIGHT: i
SIGNABLE WALL AREA (in sq. ft.): TYPL' UP 1LI,Uiv INAIAviv:
NOTE: A soeled rendering of each proposed sign must be submitted illustrating the color of rho sign and
noting the dlmeusiow of each sign.
9) DATE OF DESIGN REVIEW APPROVAL (if applicable):
10) Applicant Signature: 0. Date:
11) Signature of Land/Building Owner: Date: i
Do not write belDwth13 Une
Foe: ,� A1 �2ication: 'Rejected �pluoved�
Code Officer Signature: ,� `� Date:
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