HomeMy WebLinkAboutHS202100057 Application 2022-06-15Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #: qe-IZ�rL
1. Applicant/Owner Information/y
NAME:IfA
E-MAIL ADDRESS: 41
MAILING ADDRESS: I I
Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.5832 � Fax 434.972.4126
- 0005�
Date Paid: 12—tW l _-
Ck#����Li ldgl.�q
2. Homestay Information
TAX MAP AND PARCEL NUMBER
(ORADDRESS, IF UNKNOWN): 03060
ZONING: ACREAGE:
lu,lxA`— 8 �L
19
REBPONSIBLEAGENTNAME:
RESPONSIBLE AGENT EMAIL:
RESPONSIBLE AGENT ADDRESS
5 eC-614i
3. Verification of Requirements
md /!/:ho` 1
1Vr /1P_ V14 Zz/ 3 C
Z'rb'�>
)MESTAY NAME:
SAME AS ABOVE (OWNER)
jSLf7f RESPONSIBLE AGENT PHONE: 61 341� q 7- v V Y Z
S'-tA/L C If 47 /c. )te, 2-z-'jL
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 OWNE2J1P11I1m1
G
Zoning Off icial-
VDH Approval Date:
Conditions
M9
DAYTIME PHONE NUMBER.
Approved [ ]
DATE:
fI—/)& ?f,Z(
WE
Approved with Conditions [ ] Denied [ ]
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.albemarle.org/homestays
v. 9/17/19 1 Page 5 of 13
2 -
rn
00
U X
z�
> n
0 0
wo
O O
-
ux
zN
H
y_
H
z X
_
OJ
Q
00
F
1 n
W
C L
SY
3�
a l�0
I
ti
C
0
0
LL
P
14