HomeMy WebLinkAboutTS201600049 Application 2016-06-17Application for
Temporary Sign Permit
MI
! , CATION REQUIREMENTS; `
Temporary Sign Permit = $25
A picture or sketch of sign showing dimensions and location this application. of sign on property must be attached with
❑ Certification that notice of this application has been provided to the property owner, if owner is different
from apuiicant_
Name on Sign / Business Name: k ,( C,..J,3 i/1( f
Location of Sign / Property: 1,13s, -S-r- v . , ,3 I, �r-, i
Tax Map and Parcel: L J - i) 0 � - 4; .3 -L ),� Zoning:
Physical Street Address (if assigned):
Applicant/Business Owner (who should we cauhvdte concerning this project: C Y.. (0 ti
Address l2 �.r ��'..ir... n��J'i �`
_ City 1C .t).al 1 L4 L. State �- Zip Z Z91 �+ 7
Daytime Phone 016 Li. Fax # Ir-mail � �n&eja
Owner of Record
Please M out the followiee:
What number permit is this for your business this year? Depending on the zoning district the maximum size of the sign will be
(check one) (Us will be verified by stag) ❑ 24 square feet
32 square Feet
V, - ❑ 2•d ❑ 3'a ❑ 41h ❑ 51h ❑ 6'h Dates you are requesting the sign to be W place.
What type of temporary sign are you proposing?�pu�
(check one)
❑ PORTABLE ❑ A-FRAMCi
Depending on the zoning district the maximum height of the sign will be
(check one)
�(12 feet if freestanding ❑ 20 feet if on a wail ❑ 30 feet if on a wall
The required setback from public street right of way will be
5 feet
/ Agent's Signature
My
OFFICE USE ONLY
Fee amrnmt $ ' "`` Date Paid 13 l b Check* 28 gy
When entering the dates above, please keep in mind the followkg
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
Fmlbmemeut Officer during regular business hours only.
• A maximum of two permits will be accepted for review for
each establishment at one time.
• Please note that an establishment is not
permitted more than arty f6QZdays of
Date
Date
Receipt # �QftOi By -E�- Permit 4 lJ
County of Albemarle Department of Community Development
401 McIntire Road Charlottesvipe, VA 22902 Voice: (434) 296-5932 Fax: (434) 9724126
4/26/2012 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 Qearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, P f—
Co t�applic�atin�arne d numb ]
was provided to �- >2 �j the owner of record of Tax Map
[name(s) of the rec owners of the parcel]
and Parcel Number 0 6 [ 2. J - �3 by delivering a copy of the application in the
manner identified below:
z Hand delivering a copy of the application to
[Name of the record Owner It -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
Y Mailinga copy
OPy of the application to aL7 r5 r,,. I L, — 5• S Q L l✓ L
[Name of the record
owner is a person;
if the owner of record is an entity, identify the recipient of the record
anner if e d the recipient's title r
office for that entity]
on co — `L! to the following address:
Date
J, z Z 9 .T
[address; written notice mailed to the owner at the last known address ofthe owner as shown on
this requirement].
the current real estate tax assessmen#books or current real estate tax assessment records satisfies
— 4--
Signature of Applicant
CA,1\ e _ S" r-4-cl + I
Print Applicant Name
(- I - fry
Date