HomeMy WebLinkAboutTS201600082 Application 2016-10-26Application for
Temporary Sign Permit
Temporary Sign Permit = S27
ATTACH 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:�ap%� Zoning:
Physical Street Address (if assigned):
Applicant(Busfness Owner (Who should we callAwite cone ming this project?):
Address City C'e YV State I Zipm)a 1
Daytime Phone �Q� Fax t;Li -7q i E-m_k&EV_4t� I clan
ail
Owner of Record
Please fill out the foloowiu
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)
(check one) (this will be verified by staff) 24 square feet32 square feet
❑15r ❑ 2°" ❑ 3•a 150 qm
(See 184.15.8 - I84. I4)
What type of temporary sign are you proposing?
(check one)
❑ BANNER ❑ PORTABLE ❑ A -FRAME
Depending nn 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 184.15.8 - 184.I5.14)
Owner's /Agent's Signature
Issued/Approved By
Dates you are requesting the sign to be in place.
through O
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
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 maximum of two permits will be accepted for review for each
establishment at one time-
Date
A 1 /4V�'
Date
OFFICE US��NLY � f
Fee amount $ 0 Date Paid to b14— Check 11 u !L0Lj_ By WhoT -1 eipt #� BY; Perrmit #
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
1I/I/2015 Page I 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 arAppeals, Sign Permits, Buildfn Permits i the
owner. b' ) f application is not the
I certify that notice of the application,
((�� [County application name and number]
was provided to �'JfZ,1,&v\ L
[name(s) of the record owners of the parcel] the owner of record of Tax Map
and Parcel Numberr(sws QA by delivering a copy of the application in the
manner identified below: f�
Hand delivering a copy of the application to rj.(jn
(Name of the record owner it 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 b\
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].
C�� �.
Signature of Applicant
Prinit ppli Name
`0
Date
WL
40
r-
60-4
03
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0
0
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