HomeMy WebLinkAboutTS201600037 Application 2016-06-08Application for
Temporarv.-Sien Permit
LPjTemporary Sign Permit = $27
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name: ��yi'a �Cn::
Location of Sign / Property: �i,:-��„�n � Cf ix.
rr� 7Dg
Tax Map and Parcel: 5 � b � Zoning:
Physical Street Address (if assigned):
Applicant/Business Owner( `Who' should we call/write concerning this project?):V 1( j r�rc,, Q L— r
Address �� `4 ��X�3 �o�� City � C Sr` {Jl` State Zip
Daytime Phone [ > �y 3i rs i} Fax # UO I.1� E-mail X r& @ 00Te A rf t4 G 1 . cy-,
Owner of Record
Please fill out the following:
Depending on the zoning district the maximu/32
of the sign will be
What number permit is this for your business this year? (check one)
(check one) (this will verified by staff) ®24 square feet square feet
(See 184.15.8 - 18-4. 14)
pot 2" ❑ 3'd ❑ 4w
Dates you are requesting the sign to 6e in place.
What type of temporary sign are you proposing?
(check one) a through ?jV
❑ BANNER 'E`PORTABLE ❑ 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
[ L5 feet ❑ to feet establishment at one time.
(See 184.15.8 - I8-4.15.14)
Proper Owner' gents Signature Date
SZ
Issued/Approved By Date
OFFICE USE c vLY 1rL.77 �g a '� I iS'l. may,,, ao 1 b_
Fee amount $'�] 'r Date Paid �f0 Check # By Who? Receipt # B : t=- Permit # ��
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 1
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This farm 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, r� S -
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manger identified below;
by delivering a copy of the application in the
Hand delivering a copy of the application to 1
[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 5W
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].
QSjgizn ture o plicant
PriUl't
pl"nt Name'
'.
Date
•�-
�
�
�
>.
p 49