HomeMy WebLinkAboutHS201900025 Application 2021-06-15Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt#:
1. Applicant/Owner Information
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HS#
Date Paid: UZ ( GGOq 11
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Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
By:
E MAIL ADDRESS:
n. _ •_
MAILINGADDRESS
2. Homestay Information
TAX MAP AND PARCEL NUMBER
(ORADCRESS,!FUNKNOV,N)
09000 no —
,
ZONING.
HOMESIAY NAME:
Moue e e
t S
RESPONSIBLE AGENT NAME
SAME AS ABOVE (OWNER)
RESPONSIBLE AGENT EMAIL:
0-11 C •
RESPONSIBLE AGENT PHONE:
_a _?'
RESPONSIBLE AGENT ADDRESS:
S
VR
3. Verification of Requirements
N UMBER OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
PROOF OF RESIDENCY PROVIDED?
FIOOR PLAN SKETCH PROVIDED?
aVES
NO
YES NO
vE5 NO
PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwelling z
Numberof Gue4 Rooms } 5
I
Total Off-Stmet Parking El
4. Applicant Signature
1 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 Homestays, that I understand them, and that I will abide by them.
SIGNATURE OF OWNER/APPLICANT:
DATE:
r
PRINT NAME: 0
DAYTIME PHONE NUMBER:
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- 1- aS
Approved[ ]
Zoning Official: P C
VDH Approval Date: Building Official Approval Date:
Conditions:
Approved with Conditions [ ]
Fire Marshal Approval Date:
Denied[ ]
SUBMIT ONLY THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL, AND YOUR $158 APPLICATION FEE
www.albemarle.org/devetopment/ V. 8/14/191 Page of
Provide Sketch Here or Attach Sketch to This Application
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www.albemarte.org/development/ V. 8/14/191 Page 6 of