HomeMy WebLinkAboutHS202000046 Application 2022-06-15Dow S' n ID: CF8D2CD4-7716476D-9DB3-A5E89494302B
erc,v-4.,�AtbemarleCounty
Community Development
Homestay 401 McIntire Rd., North Wing
Charlottesville, VA 22902
ZoningClearance Phone 434.296.58321 Fax434.972.4126
FOR OFFICE USE ONLY HS#`��']�������111rG�
Fee Amt: $1+53 / Date Paid' ===� B'
Receipt #: 1 l Ck# 3 a g By:
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L. APp
unmactav Infnrmation
(ORADORESS, IF UNKNOWMN ER
0
W $5 C.J
ZONING_
ACREAGE
HOMESTAYNAME
O �S
RESPONSIBLEAGEKIT NAME
SAME AS ABOVE (OWNER)
RESPONSIBLE AGENT EMAIL
RESPONSIBLE AGENT PHONE:
RESPONSIBLE AGENT ADDRESS:
3_ Verification of Reauirements
NUMBER OF GUEST BEDROOMS
USING ACCESSORY STRUCTURES!
RESIDENCY PROVDED?
FLOOR PLAN SKETCH PROVIDED?
1
YES Q
YE NO
LESJ NO
PARKING REQUIRED:
TOTAL HOMESTAY USES ON PARCEL
Dwe ling 2
Nu.b . Gu¢tRmms
A
Total ON-Sv QParlung ®
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 WNNER/APPEKANT:
DAB,
12 18 2019
l4Mt
PRINT NAME:
DAYTIME PHONE NUMBER
ga r1e a pence- elnmlc a
34- 96- 75
Approved [ ] Approved with Conditions [ ] Denied[ I
VDH Approval Date: Building Official Approval Date: Fire Marshal Approval Date:
SUBMIT ONLY THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL, AND YOUR $158 APPLICATION FEE
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DowSign Envelope ID: CF8D2CD4-7716-476D-9DB3-A5E89494302B
Provide Sketch Here or Attach Sketch to This Application
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