HomeMy WebLinkAboutTS201700037 Application 2017-06-09Application for
Temporary Sign Permit
it
e-Temporary Sign Permit = $27
ATTACH A PICTURE OR SKETCH OF SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business
Location of Sign / Property: n11�'I h 1 l� ttI l l �n 0 )0a r
Tax Map and Parcel: . '1� C Zonin
Physical Street Address (if assigned):650—M
Applicant/Business Owner (Who should we call/write concerning this
Address 1 b 1 11 / C�tt Cit)0_X�g e.r V
Daytime Phone y 7��Y ��� CFhz �i�J �jZ E-mail
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)
Kv
El 2nd 4th
What type of temporary sign *ary.0 proposing?
(check one)
❑ BANNER � PORTABLE ElA-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 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)
kLJ�5 feet ❑ 10 feet
(See 18-4.15.8 - 18-4.15.14)
;0
State V Zip 2?—Flo/
Depending on the zoning district the maximum size of the sign will be
(check one)
El24 square feet ❑ 32 square feet
(See 18-4.15.8 - 18-4.15.14)
Dates you are requesting the sign to be.iinlplace.
� tZZ(jl7 throua] ✓ .kkLI � 1D'fA'2017
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.
Property Owner's / Agent's Signature Date
Issued/Approved By
Date
OFFICE USE ONLY
Fee amount $ .Date Paid /aCheck # Cm By Who. \\t Receipt # By: 1_�__s Permit 3i \� .il%1'
Couniy of Albemarle Department of eommunity Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11/1/2015 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, Si
owner. gn Permits, Building Permits) if the application is not the
I certify that notice of the application, mnLta M
ounty plic t' n name and number]
was provided to � the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number - 1 6 . , "q o
manner identified below:
_Hand delivering a copy of the application to
by delivering a copy of the application in the
[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]
on6) 12'0 (7
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].
Sign •e Applic nt
Print Applicant
pplicant Nam
Date