HomeMy WebLinkAboutHS202000031 Approval - County 2022-06-17Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt #:aZ
1. Applicant/Owner Information
NAME: ice_ _r T !'
E-MAILADDRESS:
MAILING ADDRESS:
2. Homestay Information
;TAX MAP AND PARCELNUMBERR ADDRESS, IF UNKNOWN):Z41ONING: - ACREAGE:
RESPONSIBLE AGENT NAME:
RESPONSIBLE AGENT EMAIL:
RESPONSIBLE AGENT ADDRESS:
3. Verification of Requirements
DatePaidt:
Ck#_ lit —7%
rl? , Albemarle County
Community Development
it 401 McIntire Rd., North Wing
Charlottesville, VA22902
Phone 434.296.5832 1 Fax 434.972.4126
Ely: 6-4&qyIYvw�+'F-I
By: Mc
(OWNER)
NUMBER OF GUEST BEDROOMS
USING ACCESSORY STRUCTURES?
2 FORMS PROOF OF RESIDENCY PROVIDED?
FLOOR PLAN SKETCH PROVIDED?
3
YES NO
S NO
YES NO
PARKING REQUIRED: (
TOTAL HOMESTAY USES ON PARCEL
Dwelling 2
Number of Guest Rooms +�y.
Total OffStreetParking
a. 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.
DATE:
_. I DAYTIME PHONE.NLWaCR>_.._
wt.nlrerttlty Yelo nt Department
File—�_----
ed L /►q Approved with Conditions [ j Denied [ ]
Zoning Official:dh4 Date: in'JED-bl,
VDH Approval Date: Building Official Approval Date:
Conditions:
Fire Marshal Approval Date:
SUBMIT THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL (IF REQUIRED) , AND YOUR $158 APPLICATION
FEE TO COMMVELOPMENT, 401 MCINTIRE ROAD, CHARLOTTESVILLE, VA 22902
www.albemarle.org/homestays V. 9/17/19 1 Page 5 of 13