HomeMy WebLinkAboutSE202000025 Application 2022-06-03HS# 9)Q19' -nQQ 8S
Name:
HOMMESTAY CHECK OFF LIST:
ZApplication (attached)
Payment (attached)
V. Floor Plans (attached)
Abutting Letter sent/attached
Abutting Labels sent/attached
W W10
W 6 cA,Ut
GIS MAP attached
Safety Inspection email sent
Health Dept Inspection Y, N, N/A
Safety Inspection completed: Date completed:
Special Exception N _ (attached),
if yes, date set for Board review
Information noted in County View (under planning)
Application completed
Application Ready to be uploaded and Scanned
Date Scanned
�. no �,u inb0 af3�3fl
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Review Comments for HS201900033 I
Project Name: IBREAK HEART STUDIO
Date Completed: Tuesday. January 07, 2020 DepartmentDivisionl:Agencyr: Review Status:
Reviewer: Rebecca Ragsdale CDD Zoning U Pending
Does not appear to meet required 125' setback. emailed applicant to advise they may apply for a SE on 1/7120-RAR
i
Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #: _i 2-(._ (6 q_
1. Applicant/Owner Information
Albemarle County
Community Development
>= 401 McIntire Rd., North Wing
�Charlottesville, VA22902
A I'rxcfN`�A Phone 434.296.58321 Fax 434.972,4126
H5# olel— 33 Ae
Date Paid: 17 23i (- By:
Ck# t c7 Z- By: �A-L
NAME: ez0.k
E-MAILADDRESS: VY1Slez.0.� Ylp{Nt0..(.l PHONE: Yd J CAI
MAILINGADDRESS:
2. Homestay Information ��� Z(— ZO$O
TAR MAP AND PARCEL
(OR ADDRESS, IF UNKNOWN):
b �)y(,j V (eak�
ZONING: fr/E—p,
ACREAGE: 3. j
HOMESTAYNAME:
RESPONSIBLE AGENT NAME:
SAME AS ABOVE (OWNER)
RESPONSIBLE AGENT EMAIL:
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS:
3. Verification of Requirements
NUMBEROF GUEST
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
^BEDROOMS:
YES NO
YES NO
VES NO
PARKING REQUIRED:
TOTAL HOMESTAV USES ON PARCEL
Dwelling 2
Nurrberof Guest Rooms +:
Tobil OR -Street Parking ED
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 wilt abide by them.
SIGNATURE OF OWNER/APPLICANT:
DATE-
6 Oe, 4101
PRINT NAME:
DAYTIME PHONE NUMBER:
h ZZi1.
CJ 41r7 v
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.albemarle.org/homestays V. 9/17/191 Page of 23
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