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HomeMy WebLinkAboutHS202000037 Approval - County 2022-06-13Homestay Zoning Clearance FOR OFFICE USE ONLY Fee Amt: $158 Receipt#: 1. Applicant/Owner Information 2. Homestay Information Albemarle County .� Community Development m 401 McIntire Rd., North Wing +_ Charlottesville, VA 22902 E�RGiNs'~ Phone 434.296.5832 1 Fax 434.972.4126 Hs#ZD©r?'� Date Paid: Z �� By: ' f ` �'i �VVV Ck# t bo 2 By: NI TAX MAPAND PARCEL NUMB€R (OR ADDRESS, IF UNKNOWN): t1Q �� ; c ' `, U' J v 6 ZONING: ACREAGtEE: HOMESTAY NAME: LA'QAMA RESPONSIBLE AGENT NA ME: Marta, G 1 SAME 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? YES IS1 YES NO YES NO k PARKING REQUIRED: TOTAL HOMESTAY USES ON PARCEL Dwelling Z N umber of Guest Rooms + [ ' Total Off -Street Parking 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 Inomestays, that I understand them, and that I will abide by them. SIGNATURE OF ER/APPLICANT: DATE: f PRINT NAME DAYTIME PHONE NUMBER: APPROVED by the Albemarle County Community Development Departmei I, // Die 1 " & `21 Approved [L117 Approved with Conditions [ ZoningOfficial:y'�ue r�(i� �`�/G �'/ - 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 $158APPLICATION FEE TO COMMUNITY DEVELOPMENT, 401 MCINTIRE ROAD, CHARLOTTESVILLE, VA 22902 www.albemarte.org/homestays v.9/17/191 Page 5of13