HomeMy WebLinkAboutHS202000046 Approval - County 2022-10-10APPROVED
by the Albemarle County
_ rrC��o,�a��mmunity Development Department
DocuS' n Envel ID: CFBD2CD4-7716476D-9DB3-A5E8W oolu_
File _
Albemarle County
O Community Development
Homestay t 401 McIntire Rd.,North Wing
'1 chadonesville,VA22902
Zoning Clearance 1,Yyp< Phone434.296.58321 Fax 434.972.4126
FOR OFFICE USE ONLY Hs#CIAF7/ 4U
Fee Amt: $158 // Date Paid: a 4 -ao By:
Receipt#: 19, � J ,ck# -J O
art
1. Applicant/Owner information
NAME GabrTele k. Pence Kleinmichel _._
E MAILADUSS: - Zb71T'5erty@msn. c M -- PNONE. 4
RE34-996-6075
MuNG AOOREsS 3445 Semi node T�Ir
uSte 295 cltar ottesvT le —VA 22911 -
unmac►av Information
TAx MAPAND PARCEL NUMBER
(OR ADDRESS, IF UNKNOWN
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HOMESTAY NAME
CONING:
RESPONSIBLE AGENT NAME
RESPONSIBLE AGENT EMAIL:
/ iUn�J $AMEASABOYT IOWNFRI
RESPONSIBLE AGENT
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RESPONSIBLE AGENTADDRESS:
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3. Verification of Requirements
NUMBER OF GUEST BEDROOMS:
PARKING REQUIRED
Number W Guest Rooms
TOW (nf-u rt Parking
USING ACCESSORY STRUCTURES?
YES NO
TOTAL HOMESTAY'Y U.SSEESON PARCEL
I
RESIDENCYPROADED?
—.. NO
NO
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 certifythat I have
read the restrictions on Homestays, that I understand them, and that I will abide by them.
SIGNATURE Of OWNER/ARPLICANT:
_ ..
{M21N1 NAME OAYTIMf PHONE NUMBER
VDH Approval
Conditions:_
Approved with Conditions I ]
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Building Official Approval Date: Fire Marshal Approval Date:
Denied [ I
SUBMIT ONLY THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL, AND YOUR $158APPLICATION FEE
www.albemarte.org/development/ v. 8/14/191 Page 5 of 6
DowSign Enve" ID: CF8D2CD4-7716-476D-9DB3-A5E89494302B
Provide Sketch Here or Attach Sketch to This Application
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