HomeMy WebLinkAboutHS202000007 Approval - County 2022-12-02APPROVED
by the Albemarle County T rI Albemarle county
ommun7It� evelopmentDepartment 4E community Development
H o m estatte _ 401 McIntire Rd., North ing
Charlottesville, VA 22902
Zoning clearance `ii iI?cs tF Phone 434.296.5832 1 Fax 434.972.4126
FOR OFFICE USE ONLY
Fee Amt: $358
Recelptri: 12-0 Z
9-1
1. Applicant/Owner Information
NAME i2
E-MAILADDRESB: p r YV
MAIt1NGADDRESS C'
Date Paid: I III `� `-
Ckfr or->
PHONE
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TAX MAP AND PARCEL NUMBER
UNKNOWN)
(OR ADDRESS. IF
ZONING:
ACREAGE HOMESTAYNAME:
r
�lla� %arm
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as a,eeta�rAu
i�r
RESPONSIBLEAGENT NAME
SAME AS ABOVE (OWNER)
RESPONSIBtEAGENT EMAIL
y10I I
RESPoNSIBLEAGENTPHONE. '
RESPONSIBLEAGENT ADDRESS
�5
D L) l 'C �/ IX
-2 trorifiratinn of Renuirements
u
NUMBEROF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES'
PROOF OF RESIDENCY PROVIDED?
FLOORPLAN SKETCH PROVIDED? "
J
9 i/idlo
YES NO
VES% NO
YES NO
Apt Poljoij
PARKING REQUIRED:
TOTAL N6MESTAY USES ON PARCEL
/•t. (A4 G
Dwalling 2
Pn I-�CLSY s'2
b
Numr&Wr Rooms } I
�
f
A
`X
Tw10R-Sweet ParlJn6 ❑
VI
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
,....,,,—� tHat I understand them. and that I will abide bythem.
. _.... ..._.__... __._.._ _.. DATE
SIGNATUR OWNER/APPLICANT:
/a
PRINPAE'
DAY PHONE NUMBER
_c 3L(- z,-
Approved [ v'J Approved with Conditions [ ] Denied[ j
Zoning Official:
` Date:
VDH Approval Date: Building Official Approval Date: Fire Marshal Approval Date:
SUBMIT ONLYTHleoAec vrornrvrrrtr vn.r ••_. —' --.. _
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