HomeMy WebLinkAboutHS202100006 Application 2021-03-02Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #: 1O�O"` 301
1. Applicant/Owner Information
Date Paid: 3/a I a1
Cks 5\G(o
Albemarle County
Community Developm
401 McIntire Rd., North W
'1 Charlottesville, VA 22902
11YAl:l�t`�l Phone 434.296.5832 1 Fax
NAME
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E-MAILADDRESS
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I PHONE:
MAILINGADDRESS:
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' G,jI t ow G ,e 229 v-2
2. Homestay Information
TAX MAPAND PARCEL NUMBER
(ORADDRESS, IF UNKNOWN(:
jj 9 — b 3
ZONING:
ACREAGE:
HOMESTAYNAME::/
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RESPONSIBLEAGENTNAME:
WPyp SAMEAS AB (OV
qER)
RESPONSIBLE AGENT EMAIL:
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENTADDRESS:
3. Verification of Requirements
OFT
NUMBER OFGUEST BEDROOMS:
USING ACCESSORY CTURES?
2 FORMS PROOF OF RESIDENCY PROVID
FLOORPtANSKEr PROVIDE'+
3
YESIV NO
YES F— NO
YESIV N
PARKING REQUIRED:
TOTAI HOMESTAY USES ON PARED
Dwelling 2
Number dGuest Rooms #
3S
Total On -Street Parking 10
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 at I have
read the restrictions on homestays, that I understand them, and that I will abide by them.
SIGNATUREO ERfAPPU
DATE
PRINT NAME-
DAYNME PHONE NUMBER
Approved ❑
Zoning Official: D
VDH Approval Date: Building Official Approval Date:
Conditions
Approved with Conditions ❑
Fire Marshal Approval Date:
SUBMIT THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL (IF REQUIRED) , AND YOUR $158
FEE TO COMMUNITY DEVELOPMENT, 401 MCINTIRE ROAD, CHARLOTTESVILLE, VA 22902
Provide Sketch Here or Attach Sketch to This Applic
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