HomeMy WebLinkAboutPermit Permanent Sign SN-97-83 - S. BURL. FAMILY PRACTICEOffice Copy
SIGN APPLICATION
CITY OF SOUTH BURLINGTON, VERMONT
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Date (Z- t 47 19 Permit Number
9�.
Applicant IrT
to cd( evet- A e
No. Street
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Town or City
Location of sign
Name
it
State
6s(44�c)
Phone No.
(77r
Street
Square footage of sign Ste Height of Sign &ff'
Estimated cost °P'{sip°° Date of erection lZ-� ►�- 12L
Name of Erector (���►��� St61Js
Address
LO
Town or City State Phone No.
Consent of Owner:
of business No.
The above named person is duly authorized to make
appli ation on my behalf. I believe the statements contained
here are t77-
to the best of my knowledge.
(, . . >Z� %// "�
Signhture of\.Apfplicant Signature of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED APPROVED ''Date
1701-1
Reason for rejection
Issued to
Fee ComputatioCode Officer
Date
19 7V_