HomeMy WebLinkAboutHS202000053 Approval - County 2022-06-13Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt ff:
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1. Applicant/Owner Information
a ae Albemarle County
Community Development
m 401 McIntire Rd., North Wing
Charlottesville, VA 22902
rnm�ta Phone 434.296.5832 1 Fax 434.972.4126
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Date Paid 6 -- By:
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2. Homestay Information
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TAX MAPARCEL NUMB
OR ADD �DS IF UNKNOWN)ER
OV ""
V4 "� Dv _OA
ZONING:
ACREAGE:
HOMESTAYRAME
RESPONSIBLE AGENT NAME:
L`
SAMEASABOVE(OWNER)
RESPONSIBLE AGENT EMAIL
I/'44 r
RESPONSIBLE AGENT PHONE:
— G
. RESPONSIBLE AGENT ADDRESS:
3. Verification of Requirements
NUMBEROI SUFSTBEDRCC 5.
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAp SKETCH PROVIDED?
YES N�
VES NO
VFS NO
PARKING REQUIRED'
TOTAL HOMESTAY USESON PARCEL
Dwelling 2
Number 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 homestays, that I understand them, and that I will abide by them. /
SIGNATURE OF OWNER/APP ANT:
DATE:
Y
PRINT NAME.
DAYTIME PHONE NUMBER:
s APPROVED
by the Albemarle County
Zoning
Approved [✓J Approved with Conditions [ ]
VDH Approval Date: Date '1okfti% 91 I Approval Date: Fire Marshal Approval Date:
Conditions: File
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 5of13