HomeMy WebLinkAboutTS201600004 Application 2016-03-14Application for
Temporary Sign Permit
a]-
IffTemporary
Sign Permit = $27
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name: SCA Q 1 Aq,-.i CTV
Location of Sign 1 Property: 1 O t it(' {�+-' . �_> I L)"r'{A
Tax Map and Parcel: Zoning:
Physical Street Address (if assigned): <3n ME T^
Applicant/Business Owner (Who should we call/write concerning this project?): D4M it L. I�uo3EF z -
Address 13b M -'LC YL ht-�P City State Zip Zy1 3
Daytime Phone (5i4 Z )q -D N4 Fax #
Owner of Record
Please fill out the following:
What number permit is this for your business this year?
(check one) (this will be verified by staff)
®jam ❑ 2nd ❑ 3rd ❑ 41h
What type of temporary sign are you proposing?
(check one)
BANNER ❑ PORTABLE ❑ A -FRAME
Depending on the zoning district the maximum height of the sign will be
(check one)
L"112 feet if freestanding ❑ 20 feet if on a wall ❑ 30 feet if an a wall
(See 18-4.15.8 - 18-4.15.14)
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 OwnePs / Agent's Signature
E-mail, J_)AnI1QC-,5 C6LF-•/Q_} �c�t,� �tGrtY.td21
Depending on the zoning district the maximum size of the sign will be
(check one)
RT4—square feet ❑ 32 square feet
(See 184.15.8 - 184.15.14)
Dates you are requesting the sign to be in place.
/ la through h -71A.,
When entering the dates above, please keep in mind the following
information:
8€i fao ti teifiow*y stk a shall be t+etid-fibr a period Wk'
t { 15) conseaatM days after tha Wootion of tt sisr#
'quFr t1�..sigri La tdniivn��Ctw�m�a'F� �i
. p ti+e� site
toy a o* Ml > ,toN*"
�+ ,i..,'• Gn.,,: , �. .' i ;7�'�`➢1 ... i1;11 he o rvelllol fih FC -1, v:o-h
Z
Issued/Approved By -`' //_ Date
OFFICELY Y` p �-
Fee amount Date Paid Check # B Who? Z Recei t # B .9�=z Permit #
Countv of Albemarle Denartment of Communitv Develolamen
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11/1/2015 Page 1 of 1
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 ddlivering 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—/ /7i(�, /fir
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].
r
Sinature of Applicant
1DIn,A r<, .
Print Applicant Name
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