HomeMy WebLinkAboutTS201700040 Application 2017-06-09Application for
Temporary Sign Permit
4D
APPLICATION REQUIREMENTS:
❑ Temporary Sign Permit = $25
❑ A picture or sketch of sign showing dimensions and location of sign on property must be attached with
this application.
❑ Certification that notice of this application has been provided to the property owner, if owner is different
from annlicant_
Name on Sign / Business Name: U
Location of Sign / Property:
Tax Map and Parcel: 32- �tp f� Zoning: !7�
Physical Street Address (if assigned): L0- I k L?, w, j G L
7 \/
Applicant/Business Owner (Who should we call/write concerning this project?)*
Address _ D l W e s `V- M ,,� S City C L, f l t A e N V, t 1 f State �� Zip 2 "Z c�
Daytime PhoneZ (� ( J - S'-.3Fax # E-mail A- -ET o il^ �cti t C r �1 V:�4 rc, e!z+ vr4
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Owner of Recordy V 1� 2:&M l
Please fill out the following:
What number permit is this for your business this year?
(check one) (this will be verged by staff)
st ❑ 2nd ❑ 3rd ❑ 4u' ❑ 5°i ❑ 6u'
What type of temporary sign are you proposing?
(check one)
;&T-B-ANNER ❑ PORTABLE ❑ A -FRAME
Depending on the zoning district the maximum height of the sign will be
(check one)
P12 feet if freestanding ❑ 20 feet if on a wall ❑ 30 feet if on a wall
The required setback from public street right of way will be
Property
5 feet
s / Agent's Signature
Issued/Approved By
Depending on the zoning district the maxim132
of the sign will be
❑ 24 square feet squarefeet
Dates you are requesting the signs to be in place. 06,
through
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.
• Please note that an establishment is not
Permitted more than sixty (60) days of
temporary sitzns in a calendar vear-
i/
Date
OFFICE US4 ONLY ,j q
Fee amount $ Date Paid S heck # By Who?/�.'f a 4 Jl ry�-feceipt # By: G (//� permit # ( J, 0 —
County of Albemarle Department of Community Development
rJ d 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
1 4/26/2012 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,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
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]
on
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].
Signature of Applicant
Print Applicant Name
Date
1
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