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4n/DOT 17~97 (I-771 <br />~LEASE P~INT -- PRESS HARD <br /> LEAVE A BLANK BETWEEN WORDS <br /> <br /> NAME LINE I <br /> NAME LINE 2 <br /> NAME LINE 3 <br /> STREET ADDRESS <br /> CITY ST~T~ ZiP <br /> TELEpRoNE <br /> <br /> ~ E[~PHONE ' <br /> PHOPEHTY LOCATION: <br /> <br /> 7. HIGH~AY ~GUNTy ' ' <br /> <br />I I <br /> <br />I I I <br /> <br />SA. MUNICIPALITY <br /> <br />1. ADVERTISING AREA {Include border & ~im): <br /> <br /> HEIGHT WIDTH, SQUARE <br />~. Illuminating Device:~Yos ~No " <br />I. DistanceJrom center of highway to nearest corner of device <br /> <br /> ~A. Right of way at sign site" ~ FI, <br /> . Approx. Date device will be/was erected <br /> . Type Device <br /> <br /> SINGLE ~OUBLE <br /> <br />() STATE OF MINNESOTA <br /> <br /> DEPARTMENT OF TRANSPORTATION <br /> <br /> ADVERTISING DEVICE PERMIT APPLICATION <br /> <br /> - DO , ,NS. ,: PERMIT TR . TH <br /> <br /> 18. LOCATION SKETCH SPACE: <br /> (Submit sketch of property showing proposed <br /> device location, land, ties, etc,) <br /> <br />ZONING & ZONING AUTHORITY <br /> <br />Submit l~gal description of property if required. <br /> <br />Landowner, Leasee or Agent I:~lst sub~i~le.~l¥ grantlng~Jse of property or sign item below.. ' . ' <br /> <br />I, We, the undersigned, here~/dec~e [h~ all students herein are true and complete, with the same f~ce and effect as <br />given under oath, herewith '~pt the t~s and ¢~diti~s of the regulative of the Commlssi~er of Transpor~tion and lully <br />agree to comply therewith to the sat~gtion~ffie Minneso~ Depart~nt of Transp~tati~. <br /> ~{ ,~ ~,. ~' ~'~ ..; .... - ~. · <br /> <br /> Submit application with certified check f~ ~o~r fee payable to Commissioner of Transpiration, <br /> ADVERTISING DEVICE PERMIT J~ <br />dssion Is hereby granted for the c~structl~ of the device as described Jn the a~ve appli~tion, said device to be in <br />rdance with the regulations as set fodh in ~e Commissioner et Transpm~ti~'s regulati~s and ~e laws of the State <br />nnesota. ~ l~ L~al Ordinance. <br /> <br /> <br />