HomeMy WebLinkAboutHS201900014 Approval - County 2021-01-15Homestay
Zoning Clearance
FOR OFFICE USE ONLY
Fee Amt: $158
Receipt#: i I�
1. Applicant/Owner Information
Nara JAM6S U125
E.MAI, ADCRBS: bret.d0�1.G./23, e�, " aw [•
MAIL. NG.ADDRESS: rJ'{QI LLn DDrt Mn•ji/Tii.♦
2. Homestay Information
AdMAP r Or PCE rUhiBER
(ORADDFES F i`Y D:NI �—
,.OP1 NG. ACREAGE
PHONE
HONIESTAY NAME:
Albemarle County
2 Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
R/hrl`t� Phone 434.296.5832 1 Fax 434.972.4126
ey )
R6'PONSIBLE hGENT NAME .'Lf 7E AS ABOVE
PESPONSIBLEAGE`:T EMAIL S -e above. RESPONSIBLEAGENT PHONE: See LC f10 t/E
RE6PONSIBLi aG`-_^.TADDPESS: C A o A/n.,.r®
3. Verification of Requirements
NUMu ROr'UESTGEDR OM',
I LSIIGA CESORiSTRI CTURES'
PROOFOFRESIDESCVPROVIDED?
FLOOR PLANSKETCH PROVIDED'
Q
YES NO
'rES VO
'IE:S 't;
PARKING REQUIRED:
-
TOTALHOMESTAVUSES ON PARCEL
Dwelling Z
Number of Guest P.aams + /
Totat off-sreet Parking
1
is �IGN►u
4. Applicant Signature
1 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
yo��fp—Homestays, that I understand them, and that I will abide by them.
P,V,T NAt.?E:
DAYTIME PHONE NJMBER:
Approved Approved with Conditions [ ] Denied[ ]
Zoning Official: ° Date. a,n
VDH Approval Date: q uilding Official Approval Date: i M it Fie Marshal Approval Date:
Conditions:
SUBMIT ONLY THIS PAGE, YOUR SKETCH, YOUR VDH APPROVAL, AND YOUR $158 APPLICATION FEE
www.aIbemar[e.org/development/ v. 8/14/191 Page 5of6
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Working together
for a healthy community
1138 Rose Hill Drive . PO Box 7546
Charlottesville, Vvgmia 2290E
THOMAS JEFFERSON HEALTH DISTRICT
TRANSIENT LODGING REVIEW
Operating Name of Business: 'Peaceful Acres AirBnB
Facility Address:
Tax Map Number:
7391 Harris Mountain Lane, Dyke, VA 22935
7-52C
Section: — Lot:
Owner/Agent: James L. Hayhurst & Debra Dodge Home phone: 434-978-7391
Address: 7391 Harris Mountain Lane cell Phone: 434-364-4141
Dyke, VA 22935 Email: debmdodgel23@gmail.com
Will food be prepared for guests? nO
Total Number Bedrooms: Owner -occupied: , Guest:
Water Source (check appropriate): Public Water System p Private Well X
Other (please specify):
Sewage Disposal (check appropriate): Public Sewer Private Septic X
Will the proposed lodging involve any new construction? no
if so, please specify:
Digan4y 491e sy 1,tl>L.
James L. Hayhurst 3 hu a 11 Oct 2019
Signature (owner or agent) __ Cale 2019 10111331 i2 w' Date:
Neolth Department Use _
VDN PERMITTING REQUIRED: s B&B Permit ` Hotel Permit None Required
SEWAGE DISPOSAL SYSTEM:
ADEQUATE
A review of our records and/or assessment by a licensed professional, and all other
information available, has indicated that the existing sewage disposal system (SDS)
and reserve area (where indicated) appears to have been designed with adequate
capacity for the proposed use. This does not imply that the existing SDS will
continue to function properly for any minimum period. A site visit and inspection
may not have been performed.
• Note: For optimum preventative care, septic tanks should be pumped out by a licensed
sewage hauler every 3 to 5 years.
INADEQUATE
A review of our records and/or assessment by a licensed professional, and all other
information available, has indicated that the existing sewage disposal system is not
adequate for the proposed use.
WATER SOURCE: Approved Not Approved
• B&B (w/ food service) & Hotel: coliform bacteria & nitrate testing required
initially, then annually thereafter, prior to permit renewal.
• Transient lodging w/o food service: coliform bacteria & nitrate testing
recommended initially, then annually thereafter.
COMMENTS:
(9-�.�ia3W�. Vtaoi
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Heal epartment fficial
Date