HomeMy WebLinkAboutTS201700032 Application 2017-05-09Application for
r-n r . —
1 emporary sign hermit
.N Temporary Sign Permit = $27
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Nance on Sign / Business Name:
Location of Sign / Property:
Tax Map and Parcel: UD 10J — �}� a� Zoning: 11 — N�
Physical Street Address (if assigned): _� J1 �p
Applicant/Business Owner (Who should we call/write concerning this project?)
Address 0 \ �_ _-_ City — _,Iu State V l^ ZipCA:11S
Daytime Phone qN Fax fi E-[nail 1Y1 i- v(t' 'j y�,� . C a -,,-
Owner of Record
Please fill out the following:
What number permit is this for your business this year?
(check one) (this will be verified by staff)
(
What type of temporar, , sign are you proposing?
(check one)
❑ BANNER kPOR"TABLE ❑ A-FItAM.E
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 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 18-4.15.8 - 18-4.15.14)
Depending on the toning district the maximum size of the sign will be
(check one)
❑ 24 square feet 32 square feet
(See 18-4.15.8 - 18-4.1_.14)
CDates you are requesting the sign to be in place.
q I Q .__—through P _ ---
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.
Il 1
_rrperty O n •'s !`Agent's Signature Date
Issued/Approved By Date
OhC'ICE 0 NLN'
Pee amount 5 60Date Paid �/ Check ii �� gq(� B Who') � Ll p 1L11 � } �� �1
�')1� Receipt # B Permit it
County of Albemarle Department`of Community Development
401 McIntire .Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
1 /1/2015 Page 1 of 1
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 or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,}�` �app
[Counation name and number]
provided to a
was p S �Rss C Il�.ars 0Gvb1t -,,
oC�
[name(s) of the record ow ers of the parcei] the owner of record of Tax Map
and Parcel Number 0V 1 (X3-(-X-bb- 13a.00 _by delivering a copy of the application in the
manner identified below:
W,
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 to _ QV yAssm La , I CG l JJQ_" S ( Q, o
[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 _ �A \ 1 to the following address:
Date
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[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].
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Signature�oAppplicant
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Date
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