HomeMy WebLinkAboutHS202000010 Application 2022-06-13Homestay
N. Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
APPROVED
by the Albemarle County
Community DevelopmelDepart
Date
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File
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Date Paid: � By: N
Receipt#:�����1%vlO6b3yi Ck#
1. Applicant/Owner Information
NAME:
E-MAILADDRESS: j O
MAILING ADDRESS: I l 'Q
C By: M�
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PHONE:
Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
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TAX MAP AND PARCEL NUMBER
(OR ADDRESS, IF UNKNOWN):
U 5
ZONING:
ACREAGE: HOMESTAV NAME:
SAME AS ABOVE (OWNER)
RESPONSIBLE AGENT NAME:
RESPONSIBLE AGENT EMAIL:
RESPONSIBLE AGENT PHONE:
W.
rP, 2-7-R1t
RESPONSIBLE AGENT ADDRESS:
q VArifiration of Reouirements iJ
BEDROOMS:
USING ACCESSORY STRUCTURES?
2FORM5PROOFOF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
qYES
N0
YES NO
VES NO
Imo
POFGUESTEST
IRED:
TOTAL HOMESTAY USES ON PARCEL22
t Roams +ILarking
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.
SIGNATUR FOWNER/APPLICANT:
DATE:
't 7
PRINT NAME'
DAYTIME PHONE NUMBER:
an YYIa-55ic
N3 Sri
(l' Approv)F—
zoningOfficial: Approved with Conditions [ ]
.� Date: 25-617C -
VDH Approval Date: Building Official Approval Date: _ Fire Marshal Approval Date:.
Conditions
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. 9/17/19 1 Page 5 of 13