HomeMy WebLinkAboutTS202200023 Application 2022-09-12Temporary Sign Permit Application
FOR OFFICE USE ONLY
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Fee Amount: $ 31.20
Date Paid: By:
Application fee: $30+ Technology Surcharge: $1.20
Receipt #:
Check #: By:
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Albemarle County
Cormmnity Development
401 McIntire Rd, North Wing
ChedonewIle, VA 22902
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Phone 4N.296.5832
Name:
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Address: +I
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Mailing Address:
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Phone #:
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Business Name:
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Tax Map and Parcel #
and/or Address of the Business
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Zoning:
Staff tell fill out if unknown
Parcel Owner:
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Owner's Address:
u Please fill out the following:
What number permit is this for
your business this year?
�/ let ❑ 2nd ❑ 3rd ❑ 4th El5th ❑ 6th
(check one)
(this will be verified by staff)
What type of temporary sign are
❑ ❑
you proposing?
BANNER PORTABLE A -FRAME
(check one)
Depending on the zoning
❑ El
district the maximum height of
2 feet 20 feet 30 feet
the sign will be
if freestanding if on a wall If on a wall
(check one)
The required setback from
public street right-of-way will be
5 feet
Depending on the zoning
district the maximum size of the
24 square feet ❑ 32 square feet
sign will be
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Dates you are requesting the
to be in
9 A7-1 w7 Z I zz / 7-07-7-
sign place.
through
When entering the dates above, please keep in mind the following information:
Each permit for a temporary sign shall be valid for a period not to exceed fifteen (15) consecutive days after the erection of
the sign.
The Ordinance requires the sign to come down between permits and will be approved on -site by a Code Compliance
Officer during regular business hours only.
A maximum of two permits will be accepted for review for each establishment at one time.
Please note that an establishment is not permitted more than sixty (60) days of temoorary signs in a calendar year
Review of this application cannot begin until the application is complete and all applicable attachments and fees are submitted.
This permit will only be valid on the parcel for which it is approved.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the
information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that
I will abide by them.
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Signature 7 t CACLt �„ ��O�iY42✓
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Date / D / 7 0 tit
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Al
o2�Y OF I;il bemarle County
Temporary Sign Permit Application Community No"W
401 McIntire Rd,Rd, North Wing
Charlottesville. VA 22902
Phone 434.296.5832
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your application.
CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN
PROVIDED TO THE LANDOWNER
I certify that I will provide (or have provided)11 -notice of this clearance application,
to the owner
of Tax Map and Parcel Number 0LA500 • Go•00• oZlr, ft'1 by either delivering a
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
Hand delivering a copy of the application to the owner identified above on
Date "Vq /2oZ2
❑ Mailing a copy of the application to the owner identified above on
Date
to the following address:
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed "Z Aky e_y Ql�O-/ a
Date C� /q Zo-Z 2
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