HomeMy WebLinkAboutPermit Permanent Sign SN-92-928A - KEENE MEDICALSIGN APPLICATION
CITY OF SOUTH BURLINGTON, VERMONT
Date 19 Permit Number
Applicant g",Yy-k(
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No. Street
Town or City State Phone No.
Location of sign F;,-Veo �V
Name of business No. Street
Square footage of s/i�gn height of Sign
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Name of Erector S�v(,4► �,� .�dS y ��
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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
her 'n a true to the best of my'knowltedge.
Signature of Applicant Signatu c of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED -APPROVED Date
Reason for rejection
Issued to
Fee Computatio �A%ao
Code Off; -tie
Date
er
19
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