HomeMy WebLinkAboutHS202000055 Approval - County 2021-11-19Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #: 0�2 /
1. Applicant/Owner information
u,yE, Albemarle County
Community Development
401 McIntire Rd., North Wing
�. Charlottesville, VA 22902
Phone 434.296.5832[Fax 434.972.4126
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Date Paid: �! 062 v By: C /li! IN • rs a G
Ck# ) ?.Z 1 By:
NAME:
I Carmickard
EMAILADDRESS:
Q S O
PHONE:
MAILING ADDRESS:
Li
2. Homestay Information
TAX MAP AND PARCEL NUMBER
(OR ADDRESS, IF UNKNOWN):
CisI00 OO O O OO 10
ZONING:
ACREAGE:
HOMESTAY NAME:
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Lr kGLn4ie.)eertouo4r5 cotfn ci
RESPONSIBLE AGENT NAME:
„e,r SAM S ABOVE (OWNER)
RESPONSIBLE AGENT EMAIL:
rA 5 o r RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS:
S dLM L-
3. Verification of Requirements y
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NUMBER OFGUESr BEDROOMS:
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
S
ES NO
YES NO
VES NO
PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwelling
Z
Number of Guest Rooms
+S
Total off -Street Parking
OL
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 homestays, that I understand them, and that I will abide by them.
SIGNATURE OF OWNER/APPLICANT:
DATE:
O 10 g d0 x.o
PRINT NAME:
DAITIME PHONE NUMBER:
'F•. Cl^..v eS s-retie_ na
Syo -83�- 28�q
APPROVED
by the Albemarle County
Community Development Department Approved&,?", Approved with Conditions [ ] Denied[ ]
Date
ZoningOffifr t�._9.f%.TS. Date:-----------------
�
VDH Approval Date: uI mg Ioa Approval Date:(12- l-2 d Z� Fire Marshal Approval Date: /Di-7AZl
Conditions:
SUBMIT THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL (IF REQUIRED) , AND YOUR $158 APPLICATION
FEE TO COMMUNITY DEVELOPMENT, 401 MCI NTIRE ROAD, CHAR LOTTESVILLE, VA 22902
er
use
www.albemarle.org/homestays v. 9/17/19 1 Page 5 of 13
Provide Sketch Here or Attach Sketch to This Application
to �o8
f Or,n -E Qo-I4,912
www.a(bemar[e.org/homestays V. 9/17/191 Page 6of 13