HomeMy WebLinkAboutHS202000061 Application 2022-06-03Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt#: U 4g
1. Applicant/Owner Information
t a� Albemarle County
Community Development
°t° R 401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
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Date Paid: Q/ By L,�Em
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NAME:
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E-MAILADDRESS:
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PHONE:
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MAILINGADDRESS:
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2. Homestay Information
TAX MAP ANDPARCEL NUMBER
(OR ADDRESS, IF UNKNOWN):
1
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ZONING:
ACREAGE:
HOMESTAY NAME:
3,74
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RESPONSIBLE AGENT NAME:
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Ro$5 y�AME AS ABOVE (OWNER)
RESPONSIBLE AGENT EMAIL:
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS:
3. Verification of Requirements
NUMBER OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
2
YES NO
ES NO
YES �;;NO
PARKING REQUIRED:
TOTAL HOMESTAV USES ON PARCEL
Dwelling
Number of Guest Rooms
Total OH Street Parking
2
+2L
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:
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PRINT NAME:
DAYTIME PHONE NUMBER:
IN Ce Ro
10-4Al5-11
Zoning Official:_
VDH Approval Date:
Conditions :
Approved [ ]
Building Official Approval Date:
Approved with Conditions [ ]
Fire Marshal Approval Date:
Denied [ ]
SUBMIT THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL (IF REQUIRED) , AND YOUR $158 APPLICATION
FEE TO COMMUNITY DEVELOPMENT, 401 MCINTIRE ROAD, CHARLOTTESVILLE, VA 22902
www.albemarte.org/homestays V. 9/17/191 Page 5 of 13
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