HomeMy WebLinkAboutHS201900012 Action Letter 2020-03-20Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #: _
1. Applicant/Owner Information
,r .�,,� Albemarle County
Community Development
�= 401 McIntire Rd., North Wing
y Charlottesville, VA 22902
1RWM'Phone 434.296.58321 Fax 434.972.4126
NAME: Gi II ��Y)rl S .--e 121 V"'
E-MAILADDRESS: C(1/� �°� ��t15ke' --Z' PHONE:
MAILINGADDRESS:
2. Homestay Information
TAX MAP AND PARCEL NUMBER
(OR ADDRESS, IF UNKNOWN)
7 a
U / 3�'-
ZONING:
ACREAGE
HOMESTAY NAME:
RESPONSIBLE AGENT NAMESL/
�I P
SAME ASABOVE (OWNER))
RESPONSIBLE AGENT EMAIL:
th 5�Z �'lncr Ic 4-r-S Vl]I-e •(cNA
RESPONSIBLE AGENT
PHONE:
y Lr -7 O (r
RESPONSIBLE AGENT ADDRESS:
�?� S� S'E' Sc./. < 5 '1tip/'4es
;II-( 22 O 2
3. Verification of Requirements
NUMBER OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
L�
YES NOj
YES" NO
YES NO
PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwelling
Numberol'GuestRooms
Total Off -Street Parking
2
+-1
/
4. Applicant Signature
I hereby apply for approval to conduct the Homestay identified above, and certify that this address is my legal residence. I also certify that I have
read the restrictions on Hoestays, that I understand them, and that I will abide by them.
SIGNATUREOFOWN /A LICAN :
DATE:
PRINT NAME:
DAYTIME PHONE NUMBER:
IS1"I 6F,
2C2 ELd t '35 35
Approved [ �,}� Approved with Conditions [ ] Denied[,a ]
Zoning Official: Date: 3 ao
VDH Approval Date. O Building Official Approval Date: V46 an Fire Marshal Approval Date:
Conditions:
SUBMIT ONLY THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL, AND YOUR $158 APPLICATION FEE
www.albemarle.org/development/ v. 8/14/19 1 Page 5 of 6
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