HomeMy WebLinkAboutTS201700042 Application 2017-06-09Application for
Temporary Sign Permit
Temporary Sign Permit = $27
ATTACH A PICTURE OR SKETCH SIGN SHOWING DIMENSIONS AND LOCATION ON THE PROPERTY
Name on Sign / Business Name: � ( '� J Ny S
Location of Sign / Property: j/ A, V\ 1 O`, 4 rL
Tax Map and Parcel: Q U C)6 _Qb `0d `° C)l 4 00 Zoning:
Physical Street Address (if assigned): 1 361 J` t t k � IW
Applicant/Business Owner (Who should we calUwrite concerning this project?):
Address Co ` ty 51 d
City
Daytime Phone l' U 01 S to I i
Owner of Record
Please fill out the following-,
SYt State Zip (5uq 61�
Fax # E-mail. I.)') � 1 @ V( 7 f-Y\ 4 re ti4 a,1( U--
What number permit is this for your business this year?
�}
(check one) (this will be verified by staff)
t6ft ' ❑ 2n° ❑ 3'd ❑ 4m
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 18-4.15.8 - 184.15.14)
Depending on the zoning district the required
setback from public street right of way %sill be
(check one)
❑ 5 feet ❑ 10 feet
(See 184.15.8 - 184.15.14)
Property O vn is / Agent's Signature
Issued/Approved By
OFFICE US O Y j _
Fee amount S Date Pai - jC, r'� Chec�#a�3
Who?,
Depending on the zoning district the maximum size of the sign will be
(check one)
024 square feet b32 square feet
(See 18-4.15.8 - 18-4.15.14)
Dates you are requesting the sign to be in place.
5 1015 through 7 I
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.
(00
Date
L/,
# l /1113y J Permit# 1 �
County of Albemarle Departmen of Co Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11/]/2015 Page 1 of I
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y/N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public srer?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use: __ 3
Y/N
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula:
Required spaces:
Y/N
Items to be verified in the field:
Inspector : Date:
Notes:
Violations:
Y/N
If so, List:
Proffers:
Y/N
If so, List:
Variance:
Y/N
If so, List:
SP's:
Y/N
If so, List:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATI®lot HAS .BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
tldministrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application, 71 er1-,Dyf 1
[County application name and number]
was provided to I ''
l Y1, S'► rj�-t �'(6 (� c� �,C�►re owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number U $UU- 00 — OCR Q �y u) b delivering a co
manner identified below: y g copy of the application in the
_1---,j Hand delivering a copy of the application to V c , rt , �, 1
[Name o 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 fJ�I1��1
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].
I�ZLL-A-
Si�gnatture of licant
l Y �c�, � ,J C�
Print Applicant Name
_41(PII )
Date
Brown Toyota
May 25-31
?�
4"n4
"S,
p S�f4nW4e
UA