HomeMy WebLinkAboutHS202100012 Application 2021-04-13Homestay
Zoning Clearance Application
Albemarle County
Community Development
401 McIntire Rd., North Wing
�^s Charlottesville, VA22902
•x.�` Phone 434.296.5832 1 Fax 434.972.4126
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
Residentiallyzoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessorystructures (if built beforeAugust 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted 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 KNOWNI:
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
ACREAGE OF PARCEL
A -
NO. OF GUEST BEDROOMS:
I
USING ACCESSORY STRUCTURES?
I EYES ®NO
I WHOLE HOUSE RENTAL?
® YES ONO
2. Property Owner/Operator Information
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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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4.Signature
I hereby apply for approval to
the property or that I have ret
restrictions on homestays, thl
I
homestay identified above, and certify that this address is my legal residence, and that I own
ial ex tion to operate the homestay as a resident manager. I also certify that I have read the
id =and that I will abide by them.
SIGNATURE: I \ f � I DATE: I ':�, Z-+ - 2-o2-I
Fee Amt: $158
Date ~
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Receipt #:
rPaid:
Ck#:_
Received by:
HS# aC)ci.�'
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FOR OFFICE USE ONLY
Safety inspection date: O Pass O Fail 2nd inspection date:
VDH Food Service (if
Notes:
O Floorplan
Reviewd By:
Date:
® Pass ® Fail
® Parking ®ID
0 Approved ® Denied
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