HomeMy WebLinkAboutTS201500127 Application 2015-11-05Application for
Temporary Sign Permit
APPLICATION REQUIREMENTS:
S-femporary Sign Permit = $25
&A picture or sketch of sign showing dimensions and location of sign on property must be attached with
this application.
[ ertification that notice of this application has been provided to the property owner, if owner is different
from applicant.
Name on Sign / Business Name:
Location of Sign /Property: rr r tills Lt4Z
Tax Map and Parcel: 1-1 � 17-4 Zoning: Aq
Physical Street Address (if assigned): SCA T
Applicant/Business Owner (Who should we call/write conceming this project?): 0,kos ►s LGaanC&
Address �, y ,, City Ct V/i State C,,�l Zip
Daytime Phone (5 <s—j� 6, — 9 06 7 _ Fax # E-mail
Owner of Record
Please fill out the followine:
What number permit is this for your business this year?
(check one) (this will be verified by staff)
1st ❑ 2" ❑ 3ro ❑ 4th ❑ 5'h 06 th
What type of temporary sign are you proposing?
(check one)
&ANNER ❑ PORTABLE ❑ A -FRAME
Depending on the zoning district the maximum height of the sign will be
(check one)
❑ 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
5 feet
Property Owner's /Afent'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.
I/ r LO /
_--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
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 than sixty (60) days of
OFFICE USE ONLY �l -may
Fee amount S � • _ Date Paid 10 i� 7 SCheck # C 115 h By Wh.4,i S Receipt # fa _ 33 By: S Permit #
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
4/26/2012 Page 1 of 1
)a-�
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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]
on
Date
Mailing a copy of the application to
[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]
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].
Yignatu a of Appl' t
��nclilell,
Print Applicant Name
l� 2 7/1 --)-
Date"