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SIGN APPLICATION
CITY OF SOUTH BURLINGTON, VERMONT
19 Permit Number
Applicant _ i-Zi- / 4�U—
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No. Street �;—(D 1f �� v
Town or City
State
Phone No.
Location of sign 194)r % / A�r141 9�R ��
Names business No. Street
Square footage of sign �• l� Height of Sign
Estimated cost Date of erection
Name of Erector -j iltn stcl.iv_— SlG1'1S C��'1
Address
r �M L3urIi rr-tz_an VT S�2G `7Z�
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
hI;;
e true to the b st of my kn ledge.
e.
Signature of Applicant Si ature of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED
APPROVED Date !%8`
Reason for rejection
Issued to
Fee Computation Code Officer'
Date
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