HomeMy WebLinkAboutTS201600047 Application 2016-06-17Application for
Temporary Sign Permit
CZ
PLICATION REQUIREMENTS:2
Temporary Sign Permit = $25
A picture or sketch of sign showing dimensions and location of sign on property must be attached with
s application.
❑ Certification that notice of this application has been provided to the property owner, if owner is different
from arm icant.
Name on Sign / Business Name:
Location of Sign / Property: `t
T r` �. v o" A
Tax Map and Parcel: y 6 r3 ' _ pJ t _ j . _ , i J Zoning:
Physical Street Address (if assigned):
Applicant/Business Owner (Who should we call/write cooce�nmg ibis Pm]°ct7)= _ ,n 4 J �r i�"�(�t �} —
Address _ to 6 4 � ���L11 12.1 city -, j iv state Zip
Daytime Phone (q) q k s- 5 7 L L Fax # E-mail �,n
l
Owner of Record
What number permit is this for your business this year?
(check one) (this will be verified by staff)
X" ❑ 2nd ❑ 3^t ❑ 41" ❑ 51h0 6ro
What type of temporary sign are you proposing?
(check one)
P(BAMIEB ❑ 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 an a waH
The required setback from public street right of way wilt be
5 feet
bignature
Issued/Approved By
Depending on the zoning district the maximum size of the sign will be
❑ 24 square feet )K32 square feet
Dates w " ' ,-equesfng the sign to be in placr.
� 4-1(P. through -7 (a, 1(�
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 W 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 maxim= of two Pests will be accepted for review for
each establishment at one time,
• Please note that an establishment is not
permitted more than siXty 60) days of
r.h -
.�tA
Date
OFFICE USE ONLY ^� U 49 a
Fee amount $ XT ' " Date Paid {, 3 Check # , As I By Who? Receipt # 101901 B :
y Penmt# ys-an(
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-N 32 Fax: (434) 9724126
4/26I2012 Page 1 of 1
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Horne Occupation, Zoning Clearance, Zoning
Administrator Determinations orAppeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
1
jCounty application name an number]
was provided to +"� the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number Q LIL 13N - d manner identified below: �by delivering a copy of the application in the
Hand delivering a copy of the application to
e[Name of the record owner if the record owner is a
title or office for that
person; if the owner entity] an entityrecord is , identify the recipient of the record and the recipient's
on
Date
Mailing a copy of the application to G Ej
[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 L ! - to the following address:
Date
..3
T
[address; written notice mailed to the owner at the last ]mown address of a owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of Applicant
PrintApplicantApplicant Name
Date
CI