HomeMy WebLinkAboutTS201600026 Application 2016-05-04Application for
Temborary SiLun Permit
(91
L�TTemporary Sign Permit = $27
AILTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name:
Location of Sign / Property:
Tax Map and Parcel: � j Z� � C� & Zoning:
Physical Street Address (if assigned): 1—t-- 2_ _ _
Applicant/Business Owner (Who should we call/write concerning this project?):
;r/u `[
1-
Address ..i_ 74_ f r`e4 e0C t_x?s' t City � Le (�� U t �{� State (J Zip s
Daytime Phone' [� � Z� Fax # E-mail kIys 1 V!5
Owner of Record i/✓ti �101 L3"i�tl'Ai /del tit+
Please fill out the following:
What number permit is this for your business this year?
(check one) (this will be verified by staff)
1rt ❑ 2nd ❑ 3rd ❑ 4m
What type of temporary sign are you proposing?
(check one)
0BANNER ❑ 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
(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)
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 - 184.15.14)
�y qq Dates you arc requesting the sign to be in place.
Tr"1 1 .i(6 through? A -!I i ],r G
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 i
xceed fifteen (15) consecutive days after the erection of the Sign: ,
The Ordinance requires the sign to come down between permits and
11 be approved on -site by a Code Enforcement Officer daring 1
�aegular business hours only.
%A maximum of two permits will be accepted for review for each'
establishment at one time. '
Property Owner's / Agent's Signature Date
Issued/Approved By Date
OFFICE USE ONLY i sjmpNW- <
Fee amount $ Zj . a a Date Paid Check # o� L Q By Who? (�Qriti3i1 fil Receipt # 101011 la By: C_..�.� Permit #�S Z 0
_ _ _ r
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11/1/2015 Page 1 of I
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,
[County application name and number]
g�
was provided to TA -PAX S' 1 y+ � U ", the owner of record of Tax Map
f name(s) of the record owners of the patcell
and Parcel Number I by delivering a copy of the application in the
manner ied below:
Hand deliveringa _ �k-vrti�
copy of the application to � ug ce A-tj
[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 74 jd_2'� t is
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:
CA) M &� ". 0 ( A-Vtk
[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
l s WfgS
Print Applicant Name
Date
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