Index No. ______________
Permit No. _____________

APPLICATION FOR SIGN PERMIT

MILLCREEK TOWNSHIP
ERIE COUNTY, PENNSYLVANIA

I, the undersigned, hereby make application for a permit to erect a sign at ________________________________
__________________________ Zoning District ______________________ Height and Area _________________
Existing Signs: _________________________________________________________________________________
Type of Sign: _____________________________________ Size of Sign: __________________________________
Top of Sign: ________________________ feet above road grade, __________________________ feet above roof
Set back from: front property/right-of-way line: ______ feet & from closes side property line: __________ feet
The sign is: Illuminated _______, Non-Illuminated _______ (Flashing Promotional Signs are Prohibited)
Electrical signs will be inspected and certified by an electrical inspection agency prior to electrical use.  A written certification of inspection will be provided to the Township.
The type, location and size of proposed sign is correctly set forth hereon.  The construction of the sign will conform to Township Building Codes and pertinent Ordinances.
The permit number label will be placed on the sign in a visible place.
Other Data: ____________________________________________________________________________________
Sign below where applicable:

SIGN PERMIT
MILLCREEK TOWNSHIP, ERIE COUNTY, PA

THIS IS TO CERTIFY that Sign Permit No. _________ has been issued to ____________________________________, for property located at _________________________________ as per information on above application.  This permit is issued on the express condition that the proposed sign conforms to all applicable ordinances regulating the erection of signs in the Township of Millcreek.