HomeMy WebLinkAboutHS201900018 Application 2022-06-03 (2)Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #: 110M 14
1. Applicant/Owner Information
Date Paid: 1 l'i r , `1-�[ By]
Ck# a0A By:
Albemarle County
Community Development
401 McIntire Rd., North Wing
it
Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
NAME:
Roharca
72tcph
E-MAILADDRESS:
wcuq
Q �
.^�Q'�
PHONE:
�,�- g
MAILINGADDRESS:
[hJJool.
/�� � p��O
I1 LXJftrllfV\0(\wtc,(.t +VL Ayr- f C7
2. Homestay Information
TAX MAPAND
(OR ADDRESS,IF UNKNOWN):
J I /r lO /E, i1 Cmmonw
. C meg
ZONING:
ACREAGE:
HOMESTAY NAME:
RESPONSIBLE AGENT NAME:
�Ca _ QCob
SAME AS ABOVE (OWNER)
RESPONSIBLE AGENT EMAIL:
W e
2-003
hoo"•cOlyl
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS:
Co MMtJl On WQV+V k. CliffI Q -Z 1
3. Verification of Requirements
NUMBER OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
YES NO
VES NO
VES NO
PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwelling 2
Number of Guest Roams }
Total ON Street Parking
Total
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:
l
PRINT NAME: DAYTIME PHONE NUMBER:
e Qrca Ica o
Approved [ Vj Approved with Conditions [ ] Denied [ ]
Zoning Official: A, Date: `-Z
VDH Approval Date: Building Official Approval fire Marshal Approval Date:
Conditions:
Die— !I2 Zvi
SUBMIT THIS PAGE, YOUR SKETCH, YOUR�H APPRR OVAL 1TEQUTREI7J —, AND YOUR $158 APPLICATION
FEE TO COMMUNITY DEVELOPMENT, 401 MCINTIRE ROAD, —CH—ARMTTESVILLE,VA22902
www.albemarle.org/homestays v. 9/17/19 1 Page 5 of 13
Provide Sketch Here or Attach Sketch to This Application
1 5u(Aro orm
�-I Uu��� OWr1�'s
Ful) room
-1V���C�bn� �'l�le5� Own2fS
ran �v�
.Ska�rj A PrA.r�hran� rp
�VQ Awou h
t
VVnNo }
u Vv�
C'wP.
Vow
(caw
LkVk' n� foovY)
www.aibemarte.org/homestays v. 9/17/191 Page 6 of 13