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01/2021 Owner Parcel # Mailing Address Permit # City Date Submitted State, Zip 60 Days Day Phone Fee Cell Phone Email Property Address Subdivision Twp Section______ Applicant Applicant Same as Owner Name Address 1 Address 2 City State, Zip Day Phone Email Clay County Planning & Zoning 3510 12th Avenue South, PO Box 280 Moorhead, MN 56561-0280 Tel (218) 299-5005 Application Fee: $50.00 Sign Permit Application ---PAGE BREAK--- 01/2021 1. Size of sign face and height of sign above ground: Height above ground: Size of sign face: 2. Purpose of sign: 3. Will the sign be single or double-sided ? 4. What type of material will be used for the sign? 5. Do you intend to light the sign? 6. Cost of sign: $ Indicate on an attached Sketch Plan the location of the proposed sign and the distance it will be located from property lines and from center of adjacent roads. To the best of my knowledge, I certify that the information provided on this application and accompanying documents is true and accurate. Applicant signature: Township Office Signature: ---PAGE BREAK--- 01/2021