HomeMy WebLinkAboutTS201600058 Application 2016-07-20Application for
Temporary Sign Permit
(10
APPLICATION REQUMEM NTS:
® Temporary Sign Permit = $27
0 A picture or sketch of sign showing dimensions V-d location of sign on property must be attached with
this application.
® Certification that notice of this application has been provided to the property owner, if owner is different
from applicant.
Name on Sign / Business Name: PAYNE'S TITLE LOANS
Location of Sign / Property. ENTRANCE TO 1905 SEM INOLE TRAIL
Tax Map and Parcel.• 45-93B zoo- HC
Physical Street Address (if assigned): 1905 SEM INOLE TRAIL
Applieant(Business Owner (who shoatd we cawwrite caneemiag this project?y DARRELL PAYNE
Address 727 NORTH MAIN STREET
City CULPEPER
State VA Zip 22701
Daytime Phone (540) 661-6373 Fax # W-825-8112 E-mail payne.darrelli@gmail.com
owner of Record HEART LAND TRUST
What number permit is this for your business this year?
(c
h
eck one) (this will be verified by stab)
02- ❑yd 041s 051h ❑bh
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)
® 12 feet if freestanding ❑ 20 feet if on a wall ❑ 30 feet if en a wall
The required setback tirom public street right of way will be
5 feet
Signatore
By
5 Fec ICE
Fee amount Date Paid
Depending on the zoning district the maximum size of the sign will be
❑ 24 square feet _ ® 32 square feet
Dates you are requesting the sign to be in place.
When entering the dates above, please Deep in mind the following
information.
• Each permit for a temporary sign shall be valid for a period
not to exceed fifteen (15) consecutive days after the erection
ofthe 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 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 sixty (60) days of
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22"1 Voice: (434) 2%-SM Fax: (434) M 4126
Permit #
11/0212015 Page l 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 orAppeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, % && „See `j ,`Crd RPr27;
[County application name and number]
was provided to L 'ram 2t :5 the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number ���___ by delivering a copy of the application in the
m=Hand
ed below:
eliveringa copy of the application to lr~l' + e /Heou Z.
[Narme oft a 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
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].
'a. , Z,4-F/ W:��
Signature of Applicant
Dy?rf e ( I ?,+
Print Applicant Name
Date
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