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SIGN APPLICATION
CITY OF SOUTH BURLINGTON, VERMONT
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Date �19 Permit Number
Applicant �lU `L4A-)j /y �-
No. Street
Town or City State Phone No.
Location of sign �f�9�dL' 16unf Zo6 `f 41-61✓reju rd
Name of business No. Street
Square footage o sign s o Height ofSign
Estimated cost l� d Date of erection
Name of Erector C!/&J1L/) 6AJ 4.
Address
Town or City State Phone No.
Consent of Owner:
The above named person is duly authorized to make
application on my behalf. I believe the statements contained
nn are true to the best of my knowledge.
Cgig ature of Ap licant Signature of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED
Reason for rejection
Issued to
Fee
Date
)
Date
11/Z--6 �7
Computation) Code Officer`-
///Zt/- 19 ��
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