HomeMy WebLinkAboutHS202000027 Approval - County 2022-06-14Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $15�� d / c, L) Date Paid: v L' w
Receipt #: Ck#
FrZE 2,0-V kPr3a W
t AnnlirantlOwner Information
By:
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Albemarle County
Community Development
401 McIntire Rd., North Wing
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Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
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By: '
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NAME: (]�
E-MAILADDRESS: ✓� IN�I( ,COA • PHONE�:- � DIQ— �17D
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MAILINGADDRESS: 0 11 L
2. Homestay Information
TAX MAP AND
—6(
-00 _/+n_ QQ
(OR ADDRESS,PARCEL IF UNKNOWN):
(DipgrrA/D
6 `xJ LJ
ZONING:
ACREAGE:
HOMEESTTA-Y/NAAMMEl�
2,I)o
SAME AS ABOVE(OWN ER)
RESPONSIBLE AGENT NAME:
RESPONSIBLEAGENT EMAIL
I
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS:
2-1-Mo
IV
3. Verification of Requirements
N U MBER OF G TEST BEDROOMS:
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESI DENCY PROVI DED?
FLOOR PLAN SKETCH PROVIDED?
VFS NO
YES NO
VES NO _
PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwelling
2
Number of Guest Rooms
y t
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 WNER/AP PINT
DATE:
�Lv d'LC.Nti
PRINT NAME
DAYFI ME PHONE N UM BER:
I t4 rK
I' gdlo R D
Approved[ i Approved with Conditions [ ] Denied[ ]
ZoningOfficiat:�PV/ / / Date, I --?�
VDH Approval Date: Building Official Approval Date: APPROWEBarshal Approval Date:
Conditions: by fhpplbemadeCot inty
Date
F112
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.atbemarte.org/homestays v. 9/17/191 Page 5 of 13
01
.[Request for a waiver, modification, v ton Variation to a previously
or substitution permitted by Chapter 18 = $457 Development rezoning a
Code of Development =
OR
❑ Relief from a condition of approval = $457
Provide the following
3 copies of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
any other exhibit documents stating the
reasons for the request and addressing the
applicable findings of the section authorized
to be waived, modified, varied or substituted.
Project Name :
Provide
Planned
plan or
❑ 3 copies of the exAing approved plan
illustrating thea where the change is
requested or tye applicable section(s) or
the Code of nevelopment. Provide a
graphic r resentation of the requested
❑ 1 COV of a written request specifying the
pro/ision of the plan, code or standard for
w ich the variation is sought, and state the
r ason for the requested variation.
Current Assigned Application Number (SDP, SP or ZMA)
Tax map and parcel(s):* tr
Applicant / Contact Person N I NFe Jlpputcr— kelnu h j 4 (-� a iN/ Le /K ay
Address-2 13(a Ptl �- A Pd - city01"1Jl dAV) (l S(tate�V/4 Zip
Daytime Phone# O - 7 [ax# ( ) Email J j l Yi CL( fip f��� QYU(Gl �r
Owner of Record jj jJ f - r
Address(3b �2O( iT1�I t city�i'[U � 1`� State Zip ?0
Daytime Phone# ) ft
077 Fax# ( ) Email (]
TM WO
County of Albemarle
Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11
APPLICATION SIGNATURE PAGE
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 3)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act
on behalf of the owner of the subject parcel(s) listed in County Records. I also certify that the information
provided on this application and accompanying information is accurate, true, and correct to the best of my
knowledge. By signing this application, I am consenting to written comments, letters and or notifications
regarding this application being provided to me or my designated contact via fax and or email. This consent does
not preclude such written communication from also being sent via first class mail.
FOR OFFICE USE ONLY APPLICATION#
Date
� q- AID& - �2? 7 yC
Daytime phone number of Signatory
Fee Amount $ Date Paid
By who? Receipt # Ck#