HomeMy WebLinkAboutTS201600097 Application 2016-12-09Application for
i em ora Sp>I n rermit
�emporary Sign Permit = S27
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
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Name on Sign / Business Name:
Location of Sign / Property:T-
Tax Map and Parcel: 6"' 1 " / Z Zoning: S
Physical Street Address (if assigned):
Applicant/Business Owner (Who should vm call/vmte concemmg this protect?)
Address l ��v tXritn t.=Y--.� S'a Z City C-PA.1G-7�tV State _v/9- Zip Z ZZ a Cj
Daytime Phone L-4-4 Z f- S �i� Fax # ,k._ E-mail !;1ye4c%�-S /f 0 6*' ,/ C..
Owner of Record
Please fill out the followine:
What number permit is this for your business this year?
(check one) (this will. -be verified by staff)
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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 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 feel
(See 184.15.8 - 184.15,14)
Depending on the zoning district the maximum si3k of the sign will be
(check one)
square feet 32 square feet
(See 18-4.15.8 - 184.15,14)
,Dates you are requesting the sign to be in place.
, '
through 30,97C.
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.
b /2-b / 6
Prop er's / Agent's Signature Date
Issue(/Approved By Date
dul OFFICE U ONLY i r`
Fee amount 5 I e Pa Datid Check # J 0b5 By Who? ipt # � By: �� Pen"
Counity of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11 /1 /2015 Page I of I
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany Zoning applications (Nome Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application, l'-
(Countapplication name anif number]
was provided to C oe:�s the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number �1 —13 Z- 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
ailing a copy of the application to Vc2.✓ ,C
[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 // / Y % / 6
Date
to the following address:
W.
V0( z2
[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].
Sign.x(u;W Applicant
Print Applicant Name
I I %3 / I A�
Date
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