HomeMy WebLinkAboutTS201600085 Application 2016-10-26❑ln ❑2nd ❑Yd
Application for
Tem
Permit
Temporary Sign Permit = $27
ATTACH A PICTURE OR SKETCH O SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name:
Location of Sign / Property:
Tax Map and Parcel:
Physical Street Addre
Applicant/Business Owner (Who should we call/write conceming this project?):
Address d Ci1y01hState V Zip-Z25(s
Daytime Phone Fax # 'WI —E-mail y4% � -V(DAera hem g.
C CM..
Owner of Record
Please fill out the followin¢:
What number permit is this for your business this year?
(check one) (this will be verified by staff)
OLC
What type of temporary sign arc 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 on a wall
(See 184.15.8 - 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 18-4.15.8 - I84.15.14)
/ Agent's Signature
Issued/Approved By
Depending on the zoning district the maximum size of the sign will be
(check one)
10 24 square feet ❑ 32 square feet
(See 19 4,15.8 - 184.15.14)
Dates you are requesting the sign to be in place.
G through —AUA
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 fur review for each
establishment at one time -
t
Date
Date
OFFICE USE ONLY
Fee amount 5 00 Date Paid tCheck # !Lb-L . liy W1107 Receipt # By- jf_P-,R #
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5932 Fag: (434) 972-4126
11/I/2015 Page I of I
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form moist accompany zoning applicalfons (Home Occupation, zoning Clearance, Zoning
Administrator Determinations or Appeals, Mgn Permits, Building permits) if the application zs not the
owner.
I certify that notice of the application,
,� j� ic:ounty application name and number]
was provided to � v Q S 5 d [name(s) of the record owners of the parcel] the owner of record of Tax Map
and Parcel Number t>AL U Qt� ' � by delivering a copy of the application in the
manner identified below:
Hand delivering a copy of the application to C-q C S S
[Name of the record owner if 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 VA -A IL
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 ]mown 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 Applicani Name
Date