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COMMONWEALTH OF VIRGINIA COUNTY OF CUMBERLAND Sign Permit Application Last revised: 4/19 1. Attachments Required: Sketch or plat showing the location of the sign(s) on the property; and Sketch of the sign showing dimensions such as length and width of sign area, height, the design and wording on the sign face 2. Property Owner (who currently owns the property?): Daytime Phone: Fax 3. Applicant (who is applying on behalf of the property owners?) Daytime Phone: Fax 4. Firm Creating Sign (if not created by property owner or applicant) Firm Name: Contact: Daytime Phone: Fax 5. Sign Information Property Address & Tax Map Parcel Acreage & Sign Location on Replacing an existing sign? If so describe existing Internal Use Only FILE RECEIVED____________ RECEIPT # ---PAGE BREAK--- Page 2 of 2 Will this sign require electricity? If so describe type of service needed (Note: A building permit will also be required, see Building Inspections Department): Type of Sign (see Sec. 74- 622 for listing) Wording on sign Total Height (from ground to top of sign) ft. from ground level Double-faced sign? Yes / No Dimension of Sign (square footage of sign face) X = sq. ft. Distance from Property Lines Distance from centerline of any roadway ft. from (route # or name of rd) Sign cannot be in VDOT right of way Illuminated? Yes / No Must be shielded and not produce glare onto adj. roads or properties 6. Certification The undersigned herby certifies that all information submitted with this application is complete, true and correct. I understand any errors and/or omissions may lengthen the time to process the request. Print Name of property owner or authorized agent Date Signature of property owner or authorized agent Date 7. Approval I certify that the above sign(s) is (are) meeting all requirements of the Cumberland County Zoning Ordinance pertaining to signage. Signature of Zoning Administrator Date Cumberland County Department of Planning & Zoning ♦ Box 110 ♦ Cumberland, VA 23040 ♦ [PHONE REDACTED] ♦ Fax – [PHONE REDACTED]