HomeMy WebLinkAboutHS202100011 Application 2021-04-05Homestay
Zoning Clearance Application
+�•.• Albemarle County
i ��`r Community Development
401 McIntire Rd., North Wing
�♦ :•r Charlottesville, VA22902
Phone 434.296.5832 1 Fax434.972.4126
Submit this completed application with the following, online or to the address above: 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 beforeAugust 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
01 PcAiV— f ,e ''U��,22e
CITY,STATE,ZIP:
1c�I1
Cro ZtA IV ^a`);�-
TAX MAP PARCEL (IF KNOWN):
I j6K--of-A-1j
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
``11
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ACREAGE OF PARCEL:
'Soo
NO. OF GUEST BEDROOMS:
A
USING ACCESSORY STRUCTURES?
O YES ENO
WHOLE HOUSE RENTAL?
® YES ENO
2. Property Owner/Operator Information
NAME:
IA - ((,k *`
HOME ADDRESS:
4VAnnF�Y�I\\e yxcs
Rol Parµ +R. L \✓l
CITY, STATE, ZIP:
PHONE NUMBER:
(5Q. 1ARC)- 0 a,Stj
EMAIL:
Ckoc6er Ord Mq'L`•COM
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay of all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
it NAME:
OQ 1Qt
HOMEADDRESS:
"W�l— G('- F ('
CITY, STATE, ZIP:
Cc teu \ion aa. ..)L
PHONE NUMBER:
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EMAIL:
tC�s +1y1. S 1,•E.pisrt
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4. Signature
1 hereby apply for approval to conduct th h estay/idtifi aboveVby
certify that this address is my legal residence, and that I own
the property or that 1 have recieved a sp c' 1 except1rate thestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I under d them, a will a them.
,q �, nfrAn ais �n�t
SIGNATURE: /�� ,/// A, _„ . , DATE:
Fee Amt: $15A8 Date Paid^:
QReceipt#: \[
Ck#: 006
Received by:
HS# r}l-Eyl�'— I�
FOR OFFICE USE ONLY
Safety inspection date: O Pass O Fail 2nd inspection date: O Paw ®Fail
VDH Food Service (if
Notes:
® Floorplan ® Parking 11 ID
Reviewd By:
Date:
® Approved ® Denied
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