HomeMy WebLinkAboutTS201500118 Application 2015-10-12.A.ppiication for
Temporary Sign Permit
APPLICATION REQUIREMENTS:
❑ Temporary Sign Permit = $25
❑ A picture or s]cetch of sign sbow'ing dimensions and location of sign on property must be attached with
this application.
❑ Certification that notice of this application has been provided to the property owner, if owner is different
from a licant.
Name on Sign 1 Business Name:
Location of Sign 1 Property:
Tax Map and Parcel: LA �* — 6 ST) Ll Zoning:
Physical Street Address (if assigned): 11 L
if
Applicant/Business Owner (Mo should we callfwrite concerning this project?): ' ' i "W rl t t: ItLa ' C
Address v ��i c��1 Ci ( i 8tateV6 /Zip
Daytime Phone � t �� Fax # E -Mai I (L�+.4 P -t 1 -,-*C
Owner of Record
What number permit Is this for your business this year?
(check one) (this will be verified by staff)
❑ 19t 1:1 2nd 37d 4in p 50b ❑ 6m
What type of temporary sign are you proposing?
(check one)
[3 BANNER >6PORTABLE ❑ A -FRAME
Depending on the zoning district the maximum height of the sign will be
(cheek ane)
12 feet if freestanding ❑ 20 feet If on a wall ❑ 30 feet if on a wall
The required setback from public street right of way will be
S feet
f Aent's Signature
Issued/Approved By
Depending on the zoning district the maximum size of the sign will be
❑ 24 square feet / 32 square feet
Dates you are requesting the sign to be in place.
{ 9 i through - Ijfsi U
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 fi#teen (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
Enforcement 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 th=in sixty 001 days of
01! E
Date
Date
OFFICE USE OaY
Fee amount S tate Paid iU' �r Check # !q 3,L By who? -VA! Tet~ I jt=ipt a 1 Ul-) By: C�.'it d7 �s ao l
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296.5832 Fax: (434) 9724126
4/26/2012 Page - of 1
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE ' LANDO'V NER
This forth must accompany Zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application, _
[County application naive and number]
was provided to2)y!A�'s S t bk the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
C�
�-� Hand delivering a copy of the application to rm/-4)s
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
an
Date
Mailing a copy of the application to
[Naive of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on
Date
to the following address:
[address; written notice :mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Sign tare of licant
1-� L�
Print ApplicAnt Name
I o(,
Date
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