HomeMy WebLinkAboutHS202000010 Approval - County 2022-06-15Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #:
ace Albemarle County
' H�a Community Development
`r 401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
1. Appucant/uwner mrorina.r.nr
NAME: r 9
E-MAILADDRESS: ,Q 1 j �j
I ONE:
MAILINGADDRESS:L-
2. Homestay Information
TAX MAP PER
�r r✓
ORADDRESS,IF UNKNOWN)l
ZONING. ACREAGE:
HOMESTAY NAME:
SAMFASABOVE ;ONINFR'
ESPONSIBLEA NTN 1E:
f
RESPONSIBLEAGE
AIL:
�f�V 1
/ r
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS
V'J�S_
•� .�
3. Verification of Requirements
NUMBER OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
VES h0
D NO
VES NO
". PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwelling 2
Number of Guest Rooms
Total off Street Parking 41
1
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/APP NT A
DATE.
q
1
PRINT NAME:
DAYTIME PHONE NUMBER:
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® - -
VDH Approval Date:
Conditions
APPROVED
by the Albemarle County
Community Development Department
Date J-1Z Approvedj/N Approved with Conditions [ I Denied[ I
File
Building Official Approval Date:
Fire Marshal Approval Date:
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 5 of 23