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SIGN APPLICATION
CITY OF SOUTH BURLINGTON- VERMONT
Date 19 'At� Permit Number�--�� /
Applicant'a�
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No. Street
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Town or City
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State Phone No.
Location of sign —Rec� Un10-4lc_-�
Name of business
No. St r t
Square footage of sign er �A -
Height
of Sign-
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Estimated cost y+e,��� Date of erection
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Name of Erector �' Spa t� G r6Q,0
n `A1 Address
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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
"re,in are true to the best of my knowledge.
Si ature of Applicant Signature of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED APPROVED Date
Reason for rejection
Issued to
Fee Computation' �.Code Officer
Date 19 ��