HomeMy WebLinkAboutHS202000051 Approval - Agencies 2022-06-14APPROVED
_ by the Albemarle County
Community Development Department Albemarle county
Date _g_�� 2 tc°``'-�9 Community Development
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_ _ m 401 McIntire Rd., North Wing
File '.. --.. h Charlottesville,VA 22902
Homestay �1,�,rr Phone 434.296.5832� Fax 434.972.4126
Zoning Clearance
FOR OFFICE USE ONLY si gy.i__T�7____v
Date Paid: —L
Fee Ant: $156 By:
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Receipt #:) J
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1. Applicant)Owner Inln=On
NAM
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E. PHONE YQ�'-`-
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E-MAIL ADDRESS: Y' � 1
MAILING ADDRESS: ! I
2. Homestay Information k (t�oc ��5
7AX MAP AND PARCEL NUMBER V v A /7
U001,
(OR ADORESS,JF UNKNOWNI: HOMESTAY NAME:
ZONING: ACREAGE: In � _
p 30 acres it f er SAME ASABOVE (OwNERi
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RE ONSIBLE AGENT NAMERESPONSIBLE AGENT PHONE
RESPONSIBLE AGENT EM L:
i RESPONSIBLE AGENT ADDRESS:
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3. Verification of Requirements
USING ACCESSORISTRUCTURES? 2FORMSPROOF OF RESIDENCY PROVIDED? FLOOR PLAN SKETCH PROVIDED?
NUMBER OF GUEST BEDROOMS: YES NO YES' NO
YES
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PARKING ftEQU1RED: TOTAL HOMESTAY USES ON PARCEL
Dwelling
II Number ofGuertaaoms +� /rl'L J Fl � 9rOr-C
� TOUI Ofl-Street Parking lry,'t� V
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
.__A th .aStri�finnc mn hnmrctavi that I understand them, and that I will abide by them.
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SIGNATURE OF OWNER/APPLICANT:
. DATE:
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PRINT NAME:
DA.YNME PHONE NUMBER:
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Approved [ Approved with Conditions [ ] Denied
Zoning Official �'-R-�V� �1J Date: `Lo
VDH Approval Date: Building Official Approval Date: - Fire Marshal Approval Date:
Conditions:
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.albemarie.org/homestays v.1/" 0201Pap5of13
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v. 3/06/20201 Page 6 of 33