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HomeMy WebLinkAboutPermit Permanent Sign SN-01-47 - OCCUPATIONAL HEALTHCITY OF SOUTH BIJRLINGTON DEPARTI'i ENT OF PLANNING & ZONING 575 DORSET STREET SOUTH BURLINGTON, VERMONT 05403 (802) 846-4106 FAX (802) 846-4101 Y Permit Number SN- Application for Permanent Sign Permit 1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #) Z3 2) PPLICANT (Name, mailing address, phone and fax #) �g& 3 SIGN LOCATION (include business name address, & phone 4) TAX PARCEL ID # (can be obtained at Assessor's Office) Dig 0, 4::� I 5) SIGN ERECTOR (Name, mailing address, phone and fax #): ©714lZ (�W4 i`TGJ 10 ) L? i 6) DATE OF ERECTION q / 11 7) SIGN DATA 4.0 9 61 ► c 1,�<n WALL SIGNS (list size in sq. ft., illumination, & type such as panel or cut-out letter FREE-STANDING SIGN 1. 3c�? 1497 SIZE (in sq. ft.): 2. OVERALL HEIGHT: SIGNABLE WALL AREA (in sq. ft.): / 30 ,o -L— TYPE OF ILLUMINATION: NOTE: A scaled#nVng of each proposed sign must be submitted illustrating the color of the sign and noting the dimensions of each sign. 8) DATE OF DESIGN REVIEW APPROVAL (if applicable): 9) Applicant Signature: 10) Signature of Land/I eeeeeoeeoeeeeo�.arao,oso�eaoee 0e40040 leEoo�bgieooe��� Fee: Code Officer Signature OCCUPATIONAL HEALTH + REHABILITATION INC. �I�J'JW-, m 01wiiF,WA I OCCUP 0+ CATIONgL HtALT �ILITATION INC. VOTE : &RAF 4"TOFTTA REDUCED TQ IG FRONT