HomeMy WebLinkAboutHS202000007 Application 2022-06-16Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $1S8
Receipt #:'2-Q 2'i!S`1
n __I:.....a/n.....er informatinn
a A Albamarlt County
Community Development
4o1 McIntire Rd., North Wing
Charlottesville, VA 22902
�jr?Rcar>V' Phone 434.296.58321 Fax 434.972.4126
Date Paid: (`' "' 1 Zv?`O By- J ' ' ✓ '���
Ck#
NAME: Q. 1 1
E-MAILADDRESS: t, {- -`' PHONE: 3- S 3 - 13
MAWNG ADDRESS: p i n J s CL to d
2 Homestay information
PARCEL NUMBER
^ Q
IF UNKNOWN)
ACREAGE HOMESTAY NAME
v'�Q
MSIBLEAGENTNAME
�a,e<�d�uc(asfrkakJE
AGENT NAME
,SAMEASABOVE
(OWNER)EAGENT
EMAIL
—^/T
'
PHONE/7EAGENT
ADDRESS:
l.Al�s
'4CC' 0 `� �^
3. Verification of Requirements U
NUMBER OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
f
YES NO
YES, NO
YE54 NO
1 ✓ /l 1 ����R DLf
- f
USES ON PARCEL
nn
b L
PARKING REQUIRED:
TOTAC7iOMESTAY
�"f
Dwelling 2
�l.-GL;.SY{{SiCG
Numb rofGue Rooms
X
Taal OR-Stree[ParNng ❑
J
4. Applicant Signature
I hereby apply for approval to conductthe Homestay identified above, and certify that this address is my legal residence. I also certify that I have
re�ei rho rnctrirtinns nn Homestays. that I understand them, and that] will abide by them.
SIGNATUR OWNER/APPUCANT:
DATE:
n
1 is a°
PRINT E
DAYTMEPHONENUMBEFt
3t (e
Zoning Official:_
VDH Approval Date:
Conditions:
Approved[ ]
Building Official Approval Date:
Approved with Conditions [ ]
Fire Marshal Approval Date:
Denied[ ]
SUBMIT ONLY TNfe ......
.,
www.albemarte.org/develr,i,;-,--;;-tl!
t � f
1 t�
Z^
IDA
i
o°pn+s� ,
Y�r
7 -
IJV'/ C
-"A00
�ba �� �n I s ��a10
je y
9lo9 abed 6T/VT/9 n {1 /4uawdolanap/8io•aljewagje•mmm
Ld
old d
t r � O
—
Pak
y4y
$ t
oo\
v
uope3ilddd siy j ol 431931S Pe}}d ao SJOH 44931S ap!noad