HomeMy WebLinkAboutTS201600084 Application 2016-10-26Application for
Temporary Sign Permit
Temporary Sign Permit = S27
ATTACH A PICTURE OR SKETCH SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name:
Location of Sign / Propar�•
b '+ w
Tax Map and Parcels , Zoning:
Physical Street Address (if assigned):
7 t. %J
Applicant/Business Owner (who should we callywrite concerning this project?): v \ 1C ��nn Address_ ' Ci Stale C Zipper 1
Daytime Phone (p �' Fax # E-mail Lri
Owner of Record
Ple&se fill out the followinn;
What number permit is this for your business this year?
(check one) (this will be verified by staff) V6—
❑131 ❑ ada ❑ 3� 1-� —
What type of temporary sign are you proposin s
(check one)
❑ BANNER ❑ PORTABLE ❑ A -FRAME
Depending on the zoning district the maximum height of the sigh 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)
❑ S feet ❑ 10 feet
(See 18-4.15.8 - 19 4.15.141
thv`aer's / Agent's Signature
Issued/Approved By
OFFICE USE ONLY
Fee amount S2• Date
Depending on the zoning district the maximum size of the sign will be
(check one)
24 square feet ❑ 32 square feet
(See 184.15.8 - 19 4.15.14)
Dates you are requesting the sign to be in place.
NA3 through
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 came down between permits and
will be approved on -site by a Code Enforcement Officer during
regular business hours only.
A maximum oftwo permits will be accepted for review for each
establishment at one time_
2
Date
Date
Cheek # ! I By Whop , Receipt # �Z ( By. �!P Permit # i[j' p
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fax: (434) 972-4126
I I/l2015 Page 1 of I
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Ciearanee, Zoning
Administrator Determinations orAppeals, Mgn Permits, Building Permits) if fire application is not the
I certify that notice of the application,
[County application name and number]
was provided to
the owner of record of Tax Map
[name(s) of the record owners of the parcel]
01IU — OA3— OLN �(10
and Parcel Number by delivering a copy of the application in the
manner identified below:
&-mil T'uY04,
Hand delivering 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 �Q�A
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].
Signature of Applicant
Print ApplicanlWName
Date