HomeMy WebLinkAboutTS201600099 Application 2016-12-09APPlication for
I'eri�porary Sign Permit 1
IL'J remporaty Sign Permit = $27 ATTACH A t'ICT[1RF, UR SKF,TCH OF SIGN —
----------------------'----------- SHOWING DIMENSIONS AND LOCATION ON'I'HF. PROPERTY
------------
Name on Sign / Business Name: ) _ -- ----- -- -
_'.�
Location of Sign / Property: ra s------------ -----
Tax Map and Parcel: J t�— ri ca L ---------- ------------------
O l ---- ------ Zoning:
Physical Street Address (if'assigned): ---
Applicant/Business OHner t' ------
i � ho should we callrwntc concerning this pn)/cct?)
Address__.1 v CD 1 c ----- -- ------ --- -
- ----. city etr It,) 44eSVState ;►)e- S
Daytime Phone (_I-L311)AU= �� � � {--- I'ax R � 93__O11 � L'-mail rt_t St
Owner of Record �---------- ----- ---------
Plea____sc fiIF out the fo1� ----- -- 7-------------- - --
What number permit is :his for your business this year?
(^� . 'check one) (this will be verified b)� staff)
ll C� 2 6/3 'd f'l 41h
What type oh temporary sign are you proposing? 1
(check one)
8:��'N1=[t ❑ P0RTABL.E
Depending on the Zoning distric the maxinm)m height ul the sign will be
,� (check one)
1112 feet if freestanding D 20 feet ifon a gall
C) 30 Ieet if nu a Hall
(See 18-4.15.8 - 18-4.15.14)
Depending on the zoning district the required
setbaek from public street right nf+vay \,ill t:e
(c-)eck one)
❑ 5 feet ❑ 10 feet
----- -.- (See
Property
ner's / Agent's Signature
rssuea/Approved By
Depending on the zoning district the maximum size of the sign �tiill be
��,,�� (check one)
lld24 square feet ❑ 32 square feet
(See 18-4.15.8 - 18-4.15.14)
Dates you are requesting the sign to be in place.
through
When emering the dares above, please keep in mind the ti)Ilow:ng
infonmatiort:
Each permit for it temporary sign shall be valid for a period not to
exceed fineen (15) consecutive days alter 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 rnaxirnurn of two permits will be accepted for reaiew for each
establishn-,ent at one time.
--- 1 - -1(P
Date
i,------------ -- Date ' - —
i' OFFICE.. U, E OIs�,Y-------Nf
------------------- �
1 W amount C �_ C)atc Paw, / heck t:—_ eipt--�13tk
CounAlbemarle Department of Community Dew eloptnent—
401 McIntire Rotad Charlottesville, VA 22902 Voice: (434) 296- 832 Fax: (434) 972-4126
1 1/1/2015 Page I :,I I
CERTIFICATION THATNOTICE OF THE
APPLICATION HAS BEEN PROVIDED 1'0 THE' LANDOWNER
This form must accompany zoning applications (Home Occupation, "Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
[County application name and number]
was provided to L _ the owner of record of Tax Map
[narne(s) of the record owners of the parcel] —
and Parcel Number b _ : L _ _by delivering a copy of the application in the
manner identified below: —�--
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
Date
Mailing a copy of the application to1:�11_rZ� l� �p,yt ►4SS pc.ru key t2c
[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:
—
_ �'-4 _ L cis i 5+__L� J O •�-�" r )lei V_A- 2 �, 4) 0,. _
[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 Applicant Name ^-
Date