HomeMy WebLinkAboutHS202100008 Application 2021-03-18Homestay
Zoning Clearance Application
Submit this completed application with the following on I, ne or to the address above:
Albemarle County
jn, n Commun'ItyDevelopment
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $158
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2 + 1 spot/guest bedroom).
2. Copies of two forms of verification of residency (one government issued with photo ID+ one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentially zoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessory structures (if built before August 7, 2019) is
only permitted by -right on rural area parcels of 5+ acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
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CITY, STATE, ZIP:
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TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
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ACREAGE OF PARCEL:
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NO. OFGUEST BEDROOMS:
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USING ACCESSORY STRUCTURES? YE ONO
WHOLE HOUSE RENTAL?
®YES NO
2. Property Owner/Operator Information
NAME:
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HOMEADDRESS:
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CITY, STATE, ZIP:
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PHONE NUMBER:�rr%J�
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
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NAME:
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HOMEADDRESS:�
CITY, STATE, ZIP:
PHONE NUMBER:
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EMAIL:
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4. Signature
I hereby apply for approval to conduct the homestay identified above, and certify that this address is my legal residence, and that I own
the property or that I have recieved a special exception to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I understand them, and that I will abijsby4
SIGNATURE: � / I DATE: I 5�2 /
FOR OFFICE USE ONLY J
Fee Amt:$158 DDate'PaiFd �ov Safetyinspection date: ®Pass ($Fail 2nd inspection date: ® ail
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Receipt #: p�ORW5 VDH Food Service (if necessary): ® Floorplan ® Parking ® ID
Ck#: \ k'g `_ (� Notes: Reviewd By:
Received by:\'S P� lT�lc'K'i.41 Date:
H S # �=\ — $ ® Approved ® Denied
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