HomeMy WebLinkAboutTS201500147 Application 2015-12-18Application for
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-temporary Sign Permit t -
[�Kemporary Sign Permit = 827
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign 1 Business Name:
Location of Sign I Property:
Tax Map and Parcel:
Physical Street Address (if assigned):
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Applicant/Business Owner (Who should we call/write concerning this project?): 6 `EC KE -A__
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Address �0 � City C(Il �I State l ip %
Daytime Phone) �'51,l Fax # E-mail a c�e-
Owner of Record
Please fill out the followine:
Depending on the zoning district the maximum size of the sign will be
What number permit is this for your business this year?
(check one)
(check on11 be verified by staff)
El 24 square feet ❑ 32 square feet
(See 18-4.15.8 - 18-4.15.14)
❑1st El3rd ❑ 40
Dates you are requesting the sign to be in place.
What type of temporary sign are you proposing?
(c ck one)
through
❑ BANNER POeRTABLE ❑ A -FRAME
When entering the dates above, please keep in mind the following
Depending on the zoning district the maximum height of the sign will be
information:
(check one)
Each permit for a temporary sign shall be valid for a period not to
❑ 12 feet if freestanding ❑ 20 feet if on a wall ❑ 30 feet if on a wall
exceed fifteen (15) consecutive days after the erection of the sign.
(See 18-4.15.8 - 184.15.14)
The Ordinance requires the sign to come down between permits and
Depending on the zoning district the required
will be approved on-site by a Code Enforcement Officer during
setback from public street right of way will be
regular business hours only.
(check one)
A maximum of two permits will be accepted for review for each
❑ 5 feet ❑ 10 feet
establishment at one time.
(See 18-4.15.8 - 18-4.15.14)
Property Owner s Agent's Signature ate
Issued/Approved By Date
OFFICE US C ISLY 1 k -j
Fee amount $ •v Date Paid) 1'11 heck # 0( By Who? [.�+ I I �, Receipt # % �a� y: � Permit # 1 � Ul
County of Albemarle Department of to m-imun4ly Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fac: (434) 972-4126
11/1/2015 Page 1 of 1
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
Thisform 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:
the owner of record of Tax Map
by delivering a copy of the application in the
Hand delivering 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
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].
Signature of Applicant
Print Applicant Name /I< --,
Date
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