Sign Permit Application – Form 0800 Fill This Form Out Online or Scroll to the Bottom of this Page for a Printable Copy Sign Permit Application - Form 0800 Sign Permit Application - Form 0800 Building & Zoning Department P.O. Box 217, Independence, VA 24348 Phone: 276-773-2322 Fax: 276-773-3673 www.graysoncountyva.gov Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Name of Property Owner* First Last Tax Map Number of sign site:* 911 Address/Site of the proposed sign* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Acreage of Parcel:* Is this sign temporary or permanent?* If temporary- must be removed after 3 months- Date of Removal: MM slash DD slash YYYY What are the dimensions of the sign face?* Max Height of sign from adjacent grade?* Please check the box indicating the type of sign*Freestanding sign - Pole - Pylon - Monument - Ground or low profileWall or Fascia Signs - Attached to the buildingCanopy Sign or Marquee Sign - Attached or FreestandingProjecting Sign -Projects from a wall whose purpose is not for the signRoof Sign - Must be erected upon or above the roof or parapetMemorial Plaque or small directional painted signs under one square foot, transportation department signs, temporary signs (under 3 months) for political, real estate or other sale, campaign, drive or event may be excluded from permit requirements. Please consult with the Zoning Administrator regarding exemptions from a sign permit.Illuminated Sign from Internal or External SourceRotating Signs, Flashing or Electronic Message SignsOutdoor Advertising Sign/Billboards over 32 square feet in a Commercial, Industrial, Service Zone (not allowed in other zones)Please indicate the subtype of sign where possible For Memorial Plaque or small directional painted signs under one square foot, transportation department signs, temporary signs (under 3 months) for political, real estate or other sale, campaign, drive or event may be excluded from permit requirements. Please consult with the Zoning Administrator regarding exemptions from a sign permit.Will the sign be in a floodplain? (If Yes include Form 0500)* YES NO Form 0500 UploadMax. file size: 100 MB.Will the sign be illuminated in any way?* YES NO specify type of illumination Will the sign rotate or move in any way?* YES NO Will the sign be outside of the VDOT Right of way?* VDOT Representative/Documentation* Site Plan/Sign Dimensions:FileMax. file size: 100 MB.SIGN APPLICATIONS MUST INCLUDE A DRAWING WHICH SHOWS; 1) HEIGHT OF THE SIGN FROM ADJACENT GRADE 2) TYPE OF PLACEMENT OR FOUNDATION 3) DIMENSIONS FOR THE SIGN FACE (MESSAGE OF THE SIGN) AND 4) DISTANCE TO NEIGHBORING PROPERTY LINES and 5) DISTANCE FROM CENTERLINE OF PUBLIC STREETS/ROADS *Please use the space above or submit a separate sheet showing the required dimensions and site plan. I certify that all information listed on this application is true and correct to the best of my belief and knowledge. The approval of a zoning permit is based upon the information provided on this application; any false representation may null and void this permit. By signing this application I grant permission for an agent of the Building or Zoning Department to visit my site for necessary review and inspections. I understand that the burden of proof for VDOT right of way and placement as it relates to VDOT right of way lies with property owner and this permit does not validate any activity in the VDOT right of way without VDOT permission to do so.Signature (Property Owner):* Date* MM slash DD slash YYYY Download (PDF, 95KB)
