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HomeMy WebLinkAboutHS202000047 Application 2022-07-18Homestay FOR OFFICE USE ONLY Fee Amt: $158 Receipt #: 1I_ 1. Applicant/Owner Information Albemarle County Community Development 401 McIntire Rd., North Wing ,. Charlottesville, VA 22902 �l'>RGNt�r Phone 434.296.5832 i Fax 434.972.4126 Date Paid:. O b By. .3 Ck# Y Z gy:_�.iL�� NAME: E-MAILADDRESS: COU Q PHONE: 4 N� 3 MAILINGADDRESS: 'o\`a, Li-7 ] R C} LQfSvi q& G. nvnrcxay unvnnauun PARCEL NUMBER S, IF UNKNOWN): �A>i `(VIA (^� / l' �O ((Q 1 (ACREAGE: HOMESTAY NAME: nARED Rce% 1E AGENT NAME L_ nn C WQ SAME AS ABOVE(OWNER)E AGENT EMAIL: CiM RESPONSIBLE AGENT PHONE: q Ll- -C)g'�E AGENT ADDRESS: 3. Verification of Requirements " USING ACCESSORY STRUCTURES? 2FORM5 PROOF OF RESIDENCY PROVIDED? FLOOR PLAN SKETCH PROVIDED? ;GU,EDROOMS: YES NO YES NO YES NO FNumberof TOTAL HOMESTAY USES ON PARCEL 2v'� ��- V lIt /l1 I treet Parking © sgii�tDU I-'�\ 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 OFOWNER/APPLICANT: DATE' 1%ly/ 0 PRINT N E: DAITIME PHONE NUMBER: LAAAD AWQA Y, 43'1- - $3 Zoning Official:_ VDH Approval Date: Conditions: Approved[ ] Building Official Approval Date: Approved with Conditions [ ] Fire Marshal Approval Date: Denied[ ] 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. 9/17/191 Page of 13 Provide Sketch Here or Attach Sketch to This Application tY;5�', 8G0 s/J Vak b6'n 40k we a VA-Atbo) m zn bV,IWlrn `jeCanc� � we ; 5 0, -DQ ?GO 5jj- Q� 51�Qga Ce�i>1 So A 'JAI De G www.albemarle.org/homestays v. 9/17/19I Page 6of 13