HomeMy WebLinkAboutTS201500149 Application 2015-12-18Application for
Temporary SiLyn Permit
Temporary Sign Permit = $27
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name: —SP -at / –T
lZbLocation of Sign / Property: �QO ►� +��
Tax Map and Parcel: Zo g; 4M
Physical Street Address (if assigned):
Applicant/Business Owner (Who should we call/write concerning this project?):
Address e� LF0 City L—KA-e s-0 ty-ef �statse�
Daytime Phone l!�U _ S Fax
Owner of Record
Please fill out the followine:
What number permit is this for your business this year?
(check on (thi ill be verified by staff)
[]Jig2" ❑ 3rd ❑ 41b
What type of temporary sign are you proposing?
ck one)
❑ BANNER JOIRTABLE ❑ 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
(See 18-4.15.8 - 184.15.14)
Depending on the zoning district the required
setback from public street right of way will be
(check one)
❑ 5 feet ❑ 10 feet
(See 18-4.15.8 - 18-4.15.14)
Property
Issued/Approved By
Signature
Depending on the zoning district the maximum size of the sign will be
(check one)
❑ 24 square feet ❑ 32 square feet
(See 18-4.15.8 - 18-4.15.14)
Dates you are requesting the sign to be in place.
Kf 1K_ through 2,c; JZ�
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.
OFFICE US OILY lw
Fee amount $ Date Paid 1 y % heck # j Oa t _ By Who? • (!M I I C W4CaReceipt q ) va y: �5 � Permit # -T S�I s. I l
County of Albemarle Department of to- mmu Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11/1/2015 Page 1 of I
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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:
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
LZI(c`p1 J
/(--,
Date